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"get established" office visit

  1. #1
    Talking "get established" office visit
    Medical Coding Books
    We had a new pt come in to "get established" which we do not normally do in our practice. This pt has no past or current medical problems. The dr did not do a physical exam, only took a family history and basic back round information. What dx codeshould be used with cpt 99203? We used V700 but insurance kicked it back stating that it was not valid with that cpt. Please help.

  2. #2
    Default
    Quote Originally Posted by ladiesnoopy View Post
    We had a new pt come in to "get established" which we do not normally do in our practice. This pt has no past or current medical problems. The dr did not do a physical exam, only took a family history and basic back round information. What dx codeshould be used with cpt 99203? We used V700 but insurance kicked it back stating that it was not valid with that cpt. Please help.
    In order to bill for any new patient visit you must have all 3 key components ( history, exam and MDM) if there is no exam I'm not sure how you are coming up with 99203.
    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"

  3. #3
    Location
    Kansas City, MO
    Posts
    431
    Default
    I agree. You cannot even get a 99201 without an exam. There was no problem, so no medical neccesity for the visit. I'm guessing the insurance company would frown on paying something that wasn't necessary. Bill the patient. In the future, let the patients who want these visits know up front that they either get a physical, or need a problem to be seen...otherwise they should come in with some cash for the visit...or you limit it to a few minutes to meet the doc as a courtesy to try and grow business.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  4. #4
    Default
    Thanks for the help. I figured that was correct that no OV could be charged but I wanted to verify. I need to get back with our NP and make sure she did not do any exam.

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