Wiki E?M code new/established patient

[Kipro]

Hello,

I work for primary care provider. We see patients for pre-employment, occupational physicals. These are paid by the employer. However some of these patients are coming back for sick or preventative visit in our office. We do have disagreemet as how to bill those visits. Some think they should be billed as new patient E/M and some of us think they are established since they were seen by the proivder reglardles who is paying for the visit.
Please let me know what is the correct way for coding this visits.

Thank you

 

[rajkumar295]

E/M and Preventive care

Hi Friend,

patient establish Or New based on the u can code 99391 to 97 or 99381 to 87 based on the age,

and medicare for new patient G0438, Est G0439,

and if u find eny evalution for extra work done , U can code E/M and 25 modif, Preventive care code.

 

[thomas7331]

Hello,

I work for primary care provider. We see patients for pre-employment, occupational physicals. These are paid by the employer. However some of these patients are coming back for sick or preventative visit in our office. We do have disagreemet as how to bill those visits. Some think they should be billed as new patient E/M and some of us think they are established since they were seen by the proivder reglardles who is paying for the visit.
Please let me know what is the correct way for coding this visits.

Thank you

A new patient is defined in CPT as one that has not received a face-to-face service from that provider in three years. If the providers saw the patient in a previous visit within the prior 3 years, then the patient is established, even if that visit was not billed to the insurance or was not a sick or preventive visit. Since the work associated with a new patient, i.e. setting up a medical record and collecting the initial information, was already done at the earlier visit, it would not be appropriate to bill a subsequent visit as a new patient simply because the insurance was not previously billed. If the records are audited, it will be apparent that the patient was in fact established and that the new patient coding is not correct.

 

[Kipro]

A new patient is defined in CPT as one that has not received a face-to-face service from that provider in three years. If the providers saw the patient in a previous visit within the prior 3 years, then the patient is established, even if that visit was not billed to the insurance or was not a sick or preventive visit. Since the work associated with a new patient, i.e. setting up a medical record and collecting the initial information, was already done at the earlier visit, it would not be appropriate to bill a subsequent visit as a new patient simply because the insurance was not previously billed. If the records are audited, it will be apparent that the patient was in fact established and that the new patient coding is not correct.

Thank you

 

[doversen]

New pt E&M and preventative CPT

Hello- A followup question to this thread - what if a provider codes a new pt E&M and a new pt Preventative code? I seem to recall a while back that the E&M is new patient and the preventative would be an est. Is this true?

Thank you for your input

Darlina