# Diagnosis for new patient



## seashel11

I have a new patient that was seen in our office to establish care.  Our provider did the usual  new patient workup, but the patient didn't have anything going that I can attach a diagnosis code to.  They didn't do a physical, so I don't want to use a wellness code.  She is due for a physical in the spring, so I know if I use a wellness code that will cause a rejection when I bill her physical.  Has anyone had this situation arise, and did you find a suitable code?  Thanks!


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## wbrady

There is a code that is suitable to use V65.5 which is used when there is comething they think is feared that they may have and it is "normal exam". Hope this helps!


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## LLovett

What did they do? 

I wouldn't use the feared complaint because there wasn't one. I would use the V70.0 but I am curious when you say no physical was done. It almost sounds like all they did was history if you have no dx and from the sounds of it no exam. In that case, unless they documented time, you can't use a new patient code. Of course I'm not keen on using 99201-99205 when there is no complaint anyway, regardless of what CPT assistant might say in some cases.

This almost sounds like a meet and greet to me, in which case we don't charge anything in our offices. That way when they do come back for an actual problem or physical we can use the proper new patient code.

Laura, CPC, CPMC, CEMC


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## LTibbetts

katmryn78 said:


> What did they do?
> 
> I wouldn't use the feared complaint because there wasn't one. I would use the V70.0 but I am curious when you say no physical was done. It almost sounds like all they did was history if you have no dx and from the sounds of it no exam. In that case, unless they documented time, you can't use a new patient code. Of course I'm not keen on using 99201-99205 when there is no complaint anyway, regardless of what CPT assistant might say in some cases.
> 
> This almost sounds like a meet and greet to me, in which case we don't charge anything in our offices. That way when they do come back for an actual problem or physical we can use the proper new patient code.
> 
> Laura, CPC, CPMC, CEMC



Hi Laura, does that mean that even thought the patient has had a meet and greet, they can still be charged as a new patient if they come back again? I thought that if the patient has already been seen that it would be an established patient on the next visit. How does this work with the meet & greet. Maybe that is where I am confused. I only ask because I am still learning a lot about E&M and I don't code for clinics so this is new to me.


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## mitchellde

I am with Leslie on this.  I think once you see the patient they are established whether you charged for the visit or not.  In my opinion this sounds like a preventive encounter and I would code it that way.  If the patient has already had a preventive for the year then they will have to pay out of pocket.  Or if they have no preventive coverage they will pay out of pocket.


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## LLovett

*Meet and Greet*

CPT defines professional services as those that are face to face rendered by a physician and reported by a specific CPT code(s).

A meet and greet does not meet the definition of any specific CPT code. Generally when we do a meet and greet, the patient comes in talks to the doctor signs forms to get records from other providers and just goes over general practice issues (Rx call ins, whether or not they round at the hospital, etc). There is no exam, no MDM, and time is usually minimal.

So we don't bill anybody anything. Since we are not reporting any CPT codes the patient still meets the definition of a new patient.

Laura, CPC, CPMA, CEMC


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## LTibbetts

Thanks, Laura. I will a note of that in my notes


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## seashel11

The patient isn't due for her physical yet this year, that is why I haven't used the V70.0.  The provider did ROS X10, PE X8, family and social history.  She also had flu shots done on that day, not sure if that makes any difference.  I really don't like the meet and greet idea, we don't do those because it is so much time from the schedule for a free visit.  I am thinking maybe bill a new, nurse visit if nothing else.


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## LLovett

There is no new nurse visit.

The patient not being due for a physical doesn't mean that wasn't what was done. That is probably an insurance limitation so it is a benefit issue not a coding issue. 

The right way to code this would be the preventive codes.

Laura, CPC, CPMA, CEMC


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## mitchellde

I agree with Laura it sounds to me like the patient is wanting a free visit here.  Why would a patient seek out a new physician with no problems or complaints and it is not time for a yearly preventive. HMMMM I just have concerns on this.  It reads preventive to me and that is how I would do it.  Like Laura stated the whole not time yet is a benefit issue not a coding issue.


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## FTessaBartels

*This was preventive ... BUT*

This was definitely a preventive visit ... also you gave a flu shot, so face-to-face service WAS provided.

That being said, I'd like to weigh in on whether a "meet & greet" means ALL future visits are established.

There are, in fact, reasons why patients want the "meet & greet." For example ... they're employed by a large corporation that has employees in many states. They've just moved to your city and need to find a new doctor. They have the same insurance, and just had their annual physical three months ago. They have no complaints, but want to make sure they have a doctor to go to if they DO get sick before their next physical is due. 

ALL you really need for this visit is for the patient to complete some forms to allow for a transfer of medical records from previous physician. If you want them to fill out a new patient history questionaire, fine.  But there's no real reason to meet the doctor for anything but a quick "pleased to meet you" 5-minutes or less in the doctor's office - NOT an exam room. 

That's what I mean when I think of a "meet & greet" ... and I wouldn't code such a meeting as a face-to-face service.

For this kind of patient ... the first time the patient actually came to me for either a preventive exam or a sick visit the appropriate "new patient" code would be used. 

Just my opinion.

F Tessa Bartels, CPC, CEMC


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## seashel11

This patient was just coming to establish, sometimes we feel it is better for a patient to establish before they are having a problem.  It can be hard some days to fit a new pt visit in when they are ill, that same day.  They didn't realize it would be a problem if they didn't have a problem at the time.  Honestly, we didn't foresee that either, because most people have some problem that you can discuss.  Once in awhile, they have none.  So, you think we shouldn't see a pt to establish if they have no issues at the time?


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