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Thread: New Patient E&M

  1. #1

    Default New Patient E&M

    AAPC: Back to School
    I need some help here. The hospital I work for wants to remove all our New Patient E&M levels from our chargemaster. The thinking is that since they don't keep the records active for 3 years in our system, it would be more compliant to just not use them. This seems wrong to me. Does anyone know where I can read the rules on this? It seems like down coding to me if we don't have them.

    Thanks for your thoughts.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default They DON'T keep records for 3 years!?!

    My mouth is hanging open ... they DON'T keep records for three years?

    They should be keeping them for longer than that!

    In any case, I don't think the answer to their problem is to take the New Patient E/M codes off the chargemaster. But that's just my opinion.

    F Tessa Bartels, CPC, CPC-E/M

  3. #3


    Here's my post to your question from the Medicare Regulation thread....

    I think that is truly ignorance at it's finest if you want my opinion!

    I'd take that right up to one your head people... explain the differences in reimbursement, especially over a period of time... not to mention they are not properly coding!

    I mean, how difficult can it truly be to check to see if a patient is new or not? and the fact their records aren't active for 3 years - normally <depending on state> the records are retained for at least 7 years.

    I don't know where you could find literature on this... I can point you the direction of the difference between new and established, but you already know that... but billing an established patient every time regardless of new or not - quite frankly, that is insane. Sorry to be so blunt

    Show them this >>>>>>>>>>
    Why shouldn’t I undercode all my services just to be safe?

    With all the talk about fraud and abuse, some physicians decide to play it safe and undercode their Medicare patient visits. Undercoding is a problem for every medical practice because it decreases earned revenue and establishes false utilization patterns. Utilization patterns are closely scrutinized by the government and by many payors. Most coding experts believe all inaccurate coding is bad coding. In some cases, undercoding can flag a physician as an outlier and lead to an investigation.
    The first step to a health practice is to understand the guidelines. Many physicians undercode because of their lack of knowledge of the system. Learning to code should be an important part of every physician’s knowledge base.

    I'm on a roll with this. Also, you might want to pull up the False Claims Act:

    This prohibits:
    Knowingly presenting, or causing to be presented to the Government a false claim for payment;
    Knowingly making, using, or causing to be made or used, a false record or statement to get a false claim paid or approved by the government

    In my opinion - by submitting "established patient codes" for every patient without regard to their "new status" is a false claim because it is making it easier for the claims to get pushed through and paid.

    Any opinions on this?!!

  4. #4
    Join Date
    Apr 2007
    North Carolina


    I really had to collect myself before I responded to this question, but I gotta ask...How does he/she look in stripes??? On a serious note, this is going to send out read flags to ALL the insurance companies. Don't you think the providers bell curves are going to look a tad bit off?? I'm nearly choking on the thought of lost revenue. I'm checking around for actual regs that address this. Please be proactive, this is serious.

  5. #5
    Join Date
    Apr 2007
    Greeley, Colorado


    Shaking my head in disbelief... Are they saying that they never see new patients? I mean really...no new residents to the area? That's absurd. Not to mention that I am in total agreement with our previous colleagues' posts!
    Lisa Bledsoe, CPC, CPMA

  6. #6


    Rebecca - bell curves, red flags - good ones, I forgot about those!

    I was probably in shock LOL!!!

    Perfect example: If you are contracted with an insurance and they notice for 6 straight months "no new patient codes" are being submitted - I can 100% guarantee it would cross their minds that you are turning away new patients, which in most cases <w/o following proper protocol> is a violation of your contract - which would DEFINITELY lead to some sort of investigation... I'll leave the rest up to your imagination!!!!

  7. #7
    Join Date
    Apr 2007
    North Carolina


    I posted this scenerio on another forum and these seasoned guru's were appalled by this thought. One consultant actually mentioned a facility in Chicago that was fined millions of dollars. This facility had a superbill with only selected codes rather than a class of codes. Are the physicians aware of this pending decision? I would think they would have a lot to say.....

  8. #8
    Join Date
    Apr 2007
    Duluth, Minnesota


    I've been too shocked to even respond to this! all I can do is sit here and shake my head....and read your guys' awesomes responses!

    just WOW...
    I'd be so interested to know how this turns out, let us know ok sheffner1?!!
    Donna, CPC, CPC-H

  9. #9


    Thank you all for your support, I've been trying to gather input to present on such a crazy decision. I will definitely let you know how this goes, hopefully they listen to me.

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