Update on my previous response...
PREVIOUSLY (prior to 11/13/17), NGS had stated:
Question: When documentation is missing one of the three required elements needed to bill a new patient level of service (CPT codes 99201-99205), what E&M code should be billed?
Answer: In this circumstance, the service can be billed in one of two ways:
a. The provider can elect to use an E&M code from the outpatient “established” series (CPT codes 99211-99215), which will require only 2/3 elements.
b. The provider can elect to use the E&M range code (CPT code 99499), and submit supporting documentation of the service that will be used to price the code.
On November 13, 2017, NGS updated their E/M FAQ and changed their position:
https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/policy-education/evaluation%20and%20management/em-faq_new%20vs%20established%20patients
It now states…
Question: When documentation is missing one of the three required elements needed to bill a new patient level of service (CPT codes 99201-99205), what E&M code should be billed?
Answer: An initial level of service in both the hospital (99221-99223) and office (99201-99205) settings requires 3/3 elements. When one element is not performed for a valid reason (e.g., a patient with dementia cannot provide any history), this must be documented in the medical record and may still be counted toward the appropriate level of coding. Unless there is a valid reason documented for the missing element, initial level of care expectations have not been met and the service
is not billable. Updated 11/13/2017
This line of reasoning is more in line with what I had previously known and what other carriers (Medicare and commercial) tend to follow. I thought it was odd that they were recommending an established patient E/M for new patients!