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Transfer In Patient

  1. Default Transfer In Patient
    Medical Coding Books
    We have some patients that transfer "in" to us. My question is - if these pateints are "new" to our practice can we charge them a new patient visit? If so, what codes would I use - CPT and ICD-9?
    Thanks!!!!!

  2. #2
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    Quote Originally Posted by LanaW View Post
    We have some patients that transfer "in" to us. My question is - if these pateints are "new" to our practice can we charge them a new patient visit? If so, what codes would I use - CPT and ICD-9?
    Thanks!!!!!

    What do you mean by transfer in? Do they come from another facility/practice? If they are 'new' and haven't seen any provider in your practice or within the last 3 years by your provider (without regard to 'practice' - doesn't matter if current practice or old practice), yes you can charge a new patient. you would use new patient codes 99201 - 99205. The ICD9 would of course depend on what they are being seen for, there isn't a 'generic ICD9 for a new patient', which is what I think you meant. Please clarify if I misinterpreted
    Last edited by ARCPC9491; 09-17-2008 at 12:20 PM. Reason: clarifying

  3. #3
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    Yes I agree with ARCPC9491 - no "generic" ICD-9 code for the visit - it should be the reason why they're being seen. And use the new patient E/M level CPT accordingly. (whatever documentation supports) (providing it meets the requirements ARCPC9491 mentioned about the 3 year issue)
    I would add also though - that if it's a preventive service you'd use the new patient CPT's for those as well. (99381 - 99387).
    {that's my opinion on the posted matter}
    Last edited by dmaec; 09-17-2008 at 11:46 AM. Reason: added the green so it didn't look like only agreed with AR on the ICD-9 issue - I agree 100% with both ARCPC0491 and mbort
    Donna, CPC, CPC-H

  4. #4
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    Being new to the "practice" does not necessitate a "new patient". The patient MUST not have been seen by any of your physicians within the past 3years. It does not matter if it is a new practice or old practice that joined yours..its the physician that matters.

    I agree with Donna and ARCPC regarding the ICD-9, use whatever the reason/dx is for the visit.

  5. Default
    OOPS - i forgot to mention a very important part of the whole picture - these are OB patients - - - - - that makes a HUGE difference.......sorry! New OB patient - transferring in care after being seen out of state for antepartum care until now..
    Thanks!

  6. #6
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    Quote Originally Posted by LanaW View Post
    OOPS - i forgot to mention a very important part of the whole picture - these are OB patients - - - - - that makes a HUGE difference.......sorry! New OB patient - transferring in care after being seen out of state for antepartum care until now..
    Thanks!

    Well, I'm not an expert in OB - but here's my stab at it:

    The out of state doc should be billing for their portion of the antepartum care only.

    You also, will bill the antepartum care, but if your doc is assuming the total care (antepartum, delivery, postpartum care) you would only bill the global code depending on the type of delivery. (Of course you would also bill for the services unbundled in the global)

    You would have to coordinate w/ the other doctor's billing staff to see how many visits she was seen for. I'm sure she has her complete medical records from the other doc, and that could give you your answer. Here's why: the insurance company will carve out the reimbursement from your global code for the antepartum codes the other doctor billed and got paid for already. Meaning the other doctor has performed a 'partial service' of the 'global service' you are billing for. Basically, you will receive less reimbursement for what the other doc got paid for.

    If she only had 1-3 visits they should bill seperately codes 99201-99499 for those 1-3 visits. (Which isn't included in your global codes )

    If she had 4-6 visits - they bill 59425
    If she had 7+ visits - they bill 59426

    Now, assuming your patient has never seen any of your docs ever <which I hate to assume, but given shes out of state, I'll roll with it ) she technically IS a new patient - however, you shouldn't bill the 99201 - 99205 unless you are providing 3 antepartum visits or less, you would bill the total global package as described above.
    Last edited by ARCPC9491; 09-17-2008 at 01:26 PM.

  7. Default
    Thank you VERY much!!!!!!

  8. #8
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    Duluth, Minnesota
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    VERY well put ARCPC9491!!! I concur.
    Donna, CPC, CPC-H

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