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Thread: Chargemaster missing New Patient E&M

  1. #1

    Default Chargemaster missing New Patient E&M

    AAPC: Back to School
    I was wondering if anyone could help me. The person in charge of our Chargemaster wants to remove all new patient E&M codes from the CDM. Are there any printed regulations regarding using established E&M codes on all patients? This seems like down coding to me. Any help or information would be very helpful.

    Thank you.

  2. #2


    Why do they want to do that? because they want to LOSE money? LOL

  3. #3


    I know. They think that it would be easier than checking to see if the patient was seen in the past 3 years. I'm at a loss of what to do. We have no one that is a coder or a compliance expert working on our CDM team.

  4. #4


    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...

    I mean, how difficult can it truly be to check to see if a patient is new or not?

    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?!!
    Last edited by ARCPC9491; 09-18-2008 at 02:17 PM.

  5. #5

    Default Medicare reimbursement

    I have a question that I hope someone can help with. We are an FQHC facility. Therefore, we are reimbursed a set amount per visit. On our office visits we are reimbursed 80% of the set amount, and can bill the additional amount to the patients secondary insurance. However, on our mental health claims, we are only reimbursed 35%. We are using the specific procedure code for the visit with a 0900 revenue code. Any suggestions on how we can get reimbursed up to 80% like on our office visit codes? Thanks so much for your help.

  6. #6


    Thank you AR- I feel the same way. Its hard when you know something is wrong but there are people higher up the corporate ladder that don't want to hear. I will definitely use the information you provided, it will get me on the right track.

    Thanks again, you are a life saver.

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