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Crosswalking new pt visits to estab visits

  1. #1
    Default Crosswalking new pt visits to estab visits
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    I am very concerned: my physician just opened a new practice after being employed by a hospital for many years. All visits were billed out as new patient visits b/c we interpretted the Medicare rule to be different group......Long story short - these visits have been denied and need to be rebilled as established visits (E/Ms). I have been instructed to crosswalk all new patient codes to the established code and this concerns me greatly because the documentation isn't being consulted at all to make this decision.
    99201 = 99211, 99201 = 99212, 99203 = 99213, 99204 = 99214, & 99205 = 99215
    I have expressed my concern that this is not correct coding and could open the practice up to some serious issues, but my employer is telling me that this is how i'm expected to do my job and if i don't like it-take a hike.
    I'm scared of not having a job, yet also scared of the slammer.
    Anyone have suggestions?
    LBJ

  2. #2
    Wink
    Quote Originally Posted by LBJ View Post
    I am very concerned: my physician just opened a new practice after being employed by a hospital for many years. All visits were billed out as new patient visits b/c we interpretted the Medicare rule to be different group......Long story short - these visits have been denied and need to be rebilled as established visits (E/Ms). I have been instructed to crosswalk all new patient codes to the established code and this concerns me greatly because the documentation isn't being consulted at all to make this decision.
    99201 = 99211, 99201 = 99212, 99203 = 99213, 99204 = 99214, & 99205 = 99215
    I have expressed my concern that this is not correct coding and could open the practice up to some serious issues, but my employer is telling me that this is how i'm expected to do my job and if i don't like it-take a hike.
    I'm scared of not having a job, yet also scared of the slammer.
    Anyone have suggestions?
    If I were in your situation, I'd sit down with your employer and show them the CPT book where it tells you that established visits require only 2 of the 3 key components and where New patient visits require all 3 key components be met. I'd audit atleast 2 or 3 of the said notes and pull out the key components and see where they fall for established visits vs new patient visits, you'll also want to show them the reimbursement for the codes you come up with. This would be your opportunity to show your skills/talents in this topic. There is no way a 99201 is equivilent to 99211? 99211 doesn't even require the presence of a physician... I'd drive that point home!

    Good luck!
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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