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99203 or 99213 for an initial office visit of a hospital patient?

  1. Exclamation 99203 or 99213 for an initial office visit of a hospital patient?
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    If my doctor has a patient that he has seen at the hospital (99233, etc.) only, and then that patient schedules an initial visit at our office to become an established patient here, should I bill 99203 (as all the NP/initial visit parameters are met/performed, and technically the patient has never been to our office) or 99213 (as technically, the doctor HAS seen the patient within the last three years)? This may be the simplest/most obvious/idiotic question ever, but I would really appreciate some clarification on this!

  2. #2
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    Established...

    A. Definition of New Patient for Selection of E/M Visit Code

    "Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient."

    30.6.7

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

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    Ok, great, that's a very clear answer (and is along the lines of what I was thinking, especially with the highlighting of the "face to face" aspect). So, I will leave it as a 99213 and go eat a taco, yay, thank you!!

  4. #4
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    Quote Originally Posted by jodygo View Post
    Ok, great, that's a very clear answer (and is along the lines of what I was thinking, especially with the highlighting of the "face to face" aspect). So, I will leave it as a 99213 and go eat a taco, yay, thank you!!
    Anytime....eat a taco for me!

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