Podiatry Coding & Billing Alert

Question: How does PFSH relate to new vs. established patients?

North Carolina Subscriber

Answer: There are certain situations where the nature of the care requires a comprehensive past medical, family, and social history (PFSH), and a new patient visit would qualify, according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, staff services coordinator/billing/credentialing/auditing/coding at County of Stanislaus Health Services Agency in Modesto, California.

“A new patient visit requires all facets of the PFSH to be completed to justify a comprehensive history,” Johnson says. “This is the first time that the provider is treating the patient.”

Johnson went on to explain her point further.

“Per the Medicare Fee Schedule, the reimbursement for a new office visit [99201-99205] is higher than an established service [99212-99215],” Johnson says. “This is based on the understanding that a provider should be completing a comprehensive PFSH to ensure that they have a full understanding of the patient’s history in general, and not just in relationship to that day’s visit.”

On the other hand, the PFSH for an established patient differs.

“An established patient visit would not normally require a comprehensive history as generally this was obtained when they were a new patient and the provider can use this documentation to see if there are any contributing factors,” Johnson says. “Only an update or confirmation of any changes is needed. An established visit is generally problem-focused.”