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New Patient

  1. #1
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    Spokane Washington 50913
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    Default New Patient
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    When a new patient is seen for shot Only. For patient first office visit, can I submit new patient E&M code, since first time it was a shot only.

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by padelson View Post
    When a new patient is seen for shot Only. For patient first office visit, can I submit new patient E&M code, since first time it was a shot only.
    The only E/M you could submit is 99211. For an injection only you would not have enough documentation for any of the new patient E/M codes.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
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    Columbia, MO
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    99211 is for established patients so for a new patient that comes in for an injection and receives that injection, it would be coded with the injection admin code such as 96372 plus the J code for the drug

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Concord, NC or Rochester, NY
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    154
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    For a new patient, i would expect a provider to do a little more work than just give a shot. I sometimes wonder what goes thru their minds, as there should be some type of Hx and Ex before just giving a shot. If not then just the admin of the shot and serum as described above.

  5. #5
    Location
    Harrisburg PA
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    No, there is no face to face with a provider. All new ptn visits require a face to face with a provider. I don't recommend billing 99211 as incident-to (a pre established plan from a provider is not made) are not met. Any way if you were to bill 99211, you would forego a new ptn EM code the next time the ptn comes in to see the provider.

    The appropriate administration code for the injection provided is meant to cover the cost of staff providing the service.

    Hope this helps

    Cheryl

  6. #6
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    Quote Originally Posted by mitchellde View Post
    99211 is for established patients so for a new patient that comes in for an injection and receives that injection, it would be coded with the injection admin code such as 96372 plus the J code for the drug
    99211 can be used with new or established, it just stipulates that presence of the physician may not be required.

    Of course injection codes can be used as well but there are rules around using those. The instructions in CPT under 96372 state "Physicians do not report 96372 for injections given without direct physician supervision. To report, use 99211." So the rule of thumb is, if the physician was not there and did not supervise the injection, you would use 99211.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  7. #7
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    Columbia, MO
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    99211 is established patient only. it is not used for either. You cannot have an incident to encounter if the physician has never seen the patient before. So for a new patient injection only the provider would need to be there and would need to at least look at the patient and approve the injection. A nurse or MA may not be the initial person to see the patient and make a decision regarding a treatment and then administer that treatment without the provider being face to face with the patient first. If the provider does not see the new patient at all then there can be no bill sent. If the provider sees the patient but does not document enough for a 99201 then you can bill the injection only. If the physician is not on site even for an established patient you cannot bill the 99211 as the provider must be on site when ancillary personnel are treating patients per prior orders. That notation in the CPT book is there for outpatient facilities where there is many times not a physician in the clinic when an injection is given.
    But again a 99211 is for established patient only and only for physician use or when a physician is on site supervising a patient he has previously treated.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    Quote Originally Posted by mitchellde View Post
    99211 is established patient only. it is not used for either. You cannot have an incident to encounter if the physician has never seen the patient before. So for a new patient injection only the provider would need to be there and would need to at least look at the patient and approve the injection. A nurse or MA may not be the initial person to see the patient and make a decision regarding a treatment and then administer that treatment without the provider being face to face with the patient first. If the provider does not see the new patient at all then there can be no bill sent. If the provider sees the patient but does not document enough for a 99201 then you can bill the injection only. If the physician is not on site even for an established patient you cannot bill the 99211 as the provider must be on site when ancillary personnel are treating patients per prior orders. That notation in the CPT book is there for outpatient facilities where there is many times not a physician in the clinic when an injection is given.
    But again a 99211 is for established patient only and only for physician use or when a physician is on site supervising a patient he has previously treated.
    We are reading a lot into the original question. The CPT book does not rule out the use of 99211 on a new patient, it is just generally used for established patients that "may not require the presence of a physician". It is the only E/M code that does not have specific levels of history, exam or medical decision-making. Did you know that if you have a new patient encounter that does not meet all the levels for a new patient visit, you can use an established E/M code to report the encounter?

    We must also follow the other coding instructions when choosing codes. I assume the physician probably reviewed this patient's information and ordered the injection. This patient may have been referred from another physician or facility. The nurse followed the physician's instruction to administer the injection. The physician was not present, so we must follow the guidelines in the book as to how to code the encounter.

    I beg to differ that the note regarding use of 96372 is for outpatient facilities only. When this code was established and the information regarding the use of it came out, it very specifically states "Physicians do not report 96372 for injections given without direct physician supervision. To report use 99211". It also states "Hospitals may report 96372 when the physician is not present". I have worked in small offices where the physicians may be at the hospital and not on site when a patient comes for a scheduled injection. In those cases we must use 99211 to report the service.

    There may be differing opinions, I am just taking my information from what is instructed in the book for reporting this encounter.
    Last edited by ajs; 11-30-2011 at 11:35 AM. Reason: add
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  9. #9
    Location
    Columbia, MO
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    Quote Originally Posted by ajs View Post
    We are reading a lot into the original question. The CPT book does not rule out the use of 99211 on a new patient, it is just generally used for established patients that "may not require the presence of a physician". It is the only E/M code that does not have specific levels of history, exam or medical decision-making. Did you know that if you have a new patient encounter that does not meet all the levels for a new patient visit, you can use an established E/M code to report the encounter?

    We must also follow the other coding instructions when choosing codes. I assume the physician probably reviewed this patient's information and ordered the injection. This patient may have been referred from another physician or facility. The nurse followed the physician's instruction to administer the injection. The physician was not present, so we must follow the guidelines in the book as to how to code the encounter.

    I beg to differ that the note regarding use of 96372 is for outpatient facilities only. When this code was established and the information regarding the use of it came out, it very specifically states "Physicians do not report 96372 for injections given without direct physician supervision. To report use 99211". It also states "Hospitals may report 96372 when the physician is not present". I have worked in small offices where the physicians may be at the hospital and not on site when a patient comes for a scheduled injection. In those cases we must use 99211 to report the service.

    There may be differing opinions, I am just taking my information from what is instructed in the book for reporting this encounter.
    you cannot cange from new pt to est just because you do not meet the requirements for new patient and you may not Bill for services when a provider is not in the office. The 99311 states physician nerd not be present and that means face to face but he must be within the office suite at tje time of service. If there is no provider in the office yjen what ate you using for the supervising/ rendering provider NPI? You cannot use tje number for a provider not there.
    Dirty I disagree across the board

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
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    Quote Originally Posted by mitchellde View Post
    you cannot cange from new pt to est just because you do not meet the requirements for new patient and you may not Bill for services when a provider is not in the office. The 99311 states physician nerd not be present and that means face to face but he must be within the office suite at tje time of service. If there is no provider in the office yjen what ate you using for the supervising/ rendering provider NPI? You cannot use tje number for a provider not there.
    Dirty I disagree across the board
    I understand, but this is the way it works in the physician office.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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