Primary Care Coding Alert

Question: Could you clarify how to code a new patient visit during which the patient comes in for a physical and also to address chronic diagnoses?

- Example: A patient new to the area makes an appointment with the FP for a yearly physical and to discuss chronic diagnoses of asthma and depression. The physician performs the preventive medicine service and has a long discussion with the patient regarding the chronic diagnoses. The documentation supports the physical code and also has enough stand-alone documentation to bill an E/M with the visit. Should I bill a new patient physical with the appropriate-level new patient E/M? Or should I bill a new patient physical with the appropriate-level established patient E/M?

Colorado Subscriber

Answer: You-re right; the patient remains new throughout the initial encounter. So the FP should code such encounters with:

- 99381-99387 (Initial comprehensive preventive medicine evaluation and management of an individual -)

- 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient -) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), if you have separate documentation that supports both services.

Many practices were actually coding the preventive medicine services as new (99381-99387) and the office visits as established (99212-99215 with modifier 25) until CPT Assistant clarified the issue.

In the October 2006 CPT Assistant's Q&A, the AMA confirmed that if a preventive medicine service and an office or other outpatient service are each provided during the same patient encounter, it is appropriate to report both services as new patient codes, if the patient meets CPT's definition of a new patient as one "who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years."

Therefore, you should consider the patient's status for the encounter, not for the individual portions of the over-all encounter.