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99203 w/o an exam?

  1. #1
    Default 99203 w/o an exam?
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    Afternoon,
    One of my providers wants to know how he can bill out a new patient office visit code without having done an exam...what if the patient refuses? What if he just didn't do an exam? Would using the reduced services modifier (52) be appropriate?

    Any help/guidence is appreicated.

    Thanks!
    -Kathleen

  2. #2
    Location
    Tacoma, WA
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    1,087
    Default
    Quote Originally Posted by kathleenl View Post
    Afternoon,
    One of my providers wants to know how he can bill out a new patient office visit code without having done an exam...what if the patient refuses? What if he just didn't do an exam? Would using the reduced services modifier (52) be appropriate?

    Any help/guidence is appreicated.

    Thanks!
    -Kathleen
    You cannot use a 52 modifier on an E/M code. You can use the Established patient E/M that meets the requirements of what was done instead. You might also need to look at the counseling codes 99401-99404, depending on exactly what happened during the visit. But for a new patient you must have all three History, Exam and MDM to use those codes.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    If the patient left without exam, I would code him/her as a walkout (V64.2). You cannot code an E/M without an examination because in order to determine E/M for a new patient you need to have all 3 key com[onents(history, exam and medical decision making).

  4. #4
    Location
    Tacoma, WA
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    1,087
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    Quote Originally Posted by TonyaMichelle View Post
    If the patient left without exam, I would code him/her as a walkout (V64.2). You cannot code an E/M without an examination because in order to determine E/M for a new patient you need to have all 3 key com[onents(history, exam and medical decision making).
    But apparently you can use Time as a determining factor on a new patient E/M if it is documented, since Time can take the place of one of the other elements.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    The posted question did not indicate that the doctor spent any time with the patient. It looks like to me that the patient apparently came into the office for an appointment, probably filled out the new patient forms given to him for general history information(the history checklist for any past or present diagnosis) and reason for visit, and probably saw the doctor for a hot second and then decided not to stay for the appointment, so do you still code the new patient E/M for time spent with the doctor when the patient just made his presence known to the office?
    Last edited by TonyaMichelle; 12-07-2011 at 06:39 AM.

  6. #6
    Default
    Thanks everyone! Yes the doctor spent time with the patient, he did not note how much time. His note is great otherwise, except no exam.

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Billing based on time
    You may arrive at the level of service using total time spent face-to-face with the patient when more than 50% of the total time spent was for counseling/coordination of care.

    So go back to the doctor and have him amend his note to include all THREE of the following:
    1) total time spent Face-to-face w/ patient
    2) Amount of time spent in counseling/coordination of care (must be 51% or more)
    3) short summary of nature of discussion.

    For example: I spent 30 minutes with patient today, 100% of which was in counseling/coordination of care discussing his history, diagnoses, treatments previously tried and continuing treatment options.

    Such a statement would allow for a 99203.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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