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Wiki need help with new patient consult codes.
- Thread starter sonyajm
- Start date
Saedron
Networker
My understanding is no, you can't - or shouldn't.
You cannot use the same history/PE/MDM in one (or two) notes to bill two different codes. Much like you should not bill an E/M with a CPE code. You are only gathering the info ONCE so you bill ONCE. Also, billing twice in these regards can cause the patient to have two co-pays (i.e. two visits). I read this in a recent AAPC Cutting Edge. The month escapes me, but very recent.
If it's a new patient, I'd code a new patient visit which (depending on the documentation) will probably be in the 4 range. Of course, if the patient has no intention of continuing care with the PCP afterwards, then a consult code works better. Unless the payor does not pay consult codes in which case you are right back to E/M with the proper documentation stating patient is there at the request of Dr. X for Y purpose, etc etc.
But anyone feel free to rebut. I'm a new coder so any feedback is appreciated!
You cannot use the same history/PE/MDM in one (or two) notes to bill two different codes. Much like you should not bill an E/M with a CPE code. You are only gathering the info ONCE so you bill ONCE. Also, billing twice in these regards can cause the patient to have two co-pays (i.e. two visits). I read this in a recent AAPC Cutting Edge. The month escapes me, but very recent.
If it's a new patient, I'd code a new patient visit which (depending on the documentation) will probably be in the 4 range. Of course, if the patient has no intention of continuing care with the PCP afterwards, then a consult code works better. Unless the payor does not pay consult codes in which case you are right back to E/M with the proper documentation stating patient is there at the request of Dr. X for Y purpose, etc etc.
But anyone feel free to rebut. I'm a new coder so any feedback is appreciated!
mitchellde
True Blue
you are correct you cannot charge for two office visits on the same day, and you cannot charge a preventive in this instance since the patient did not request a preventive and the primary reason for the encounter was not preventive. You may charge the new patient encounter.
Janice - Billing Manager
I am not exactly sure what's being asked here - but I can tell you want works for us and if you feel it is not correct, please let me know. But usually (and its usually kids) coming for sports forms to be completed. Usually the kids have not had a complete CPE so that is what we do - and this will cover all the questions on the Sport Physicals as well. We usually change $12.00 to complete additional paperwork for the sports physical after CPEl is complete. If at the time the patient comes in with other issues not associated to a CPE or the filling out of the sports physical but in the course of the visit explains that he has pain in his knee that needs looking into and perhaps needs a referral to a specialist the we chose a level of e&m with modifier 25 for the balance of the visit. So that you are dealing with all the issues at once. Janice
ron;291375]My understanding is no, you can't - or shouldn't.
You cannot use the same history/PE/MDM in one (or two) notes to bill two different codes. Much like you should not bill an E/M with a CPE code. You are only gathering the info ONCE so you bill ONCE. Also, billing twice in these regards can cause the patient to have two co-pays (i.e. two visits). I read this in a recent AAPC Cutting Edge. The month escapes me, but very recent.
If it's a new patient, I'd code a new patient visit which (depending on the documentation) will probably be in the 4 range. Of course, if the patient has no intention of continuing care with the PCP afterwards, then a consult code works better. Unless the payor does not pay consult codes in which case you are right back to E/M with the proper documentation stating patient is there at the request of Dr. X for Y purpose, etc etc.
But anyone feel free to rebut. I'm a new coder so any feedback is appreciated![/QUOTE]
I am not exactly sure what's being asked here - but I can tell you want works for us and if you feel it is not correct, please let me know. But usually (and its usually kids) coming for sports forms to be completed. Usually the kids have not had a complete CPE so that is what we do - and this will cover all the questions on the Sport Physicals as well. We usually change $12.00 to complete additional paperwork for the sports physical after CPEl is complete. If at the time the patient comes in with other issues not associated to a CPE or the filling out of the sports physical but in the course of the visit explains that he has pain in his knee that needs looking into and perhaps needs a referral to a specialist the we chose a level of e&m with modifier 25 for the balance of the visit. So that you are dealing with all the issues at once. Janice
ron;291375]My understanding is no, you can't - or shouldn't.
You cannot use the same history/PE/MDM in one (or two) notes to bill two different codes. Much like you should not bill an E/M with a CPE code. You are only gathering the info ONCE so you bill ONCE. Also, billing twice in these regards can cause the patient to have two co-pays (i.e. two visits). I read this in a recent AAPC Cutting Edge. The month escapes me, but very recent.
If it's a new patient, I'd code a new patient visit which (depending on the documentation) will probably be in the 4 range. Of course, if the patient has no intention of continuing care with the PCP afterwards, then a consult code works better. Unless the payor does not pay consult codes in which case you are right back to E/M with the proper documentation stating patient is there at the request of Dr. X for Y purpose, etc etc.
But anyone feel free to rebut. I'm a new coder so any feedback is appreciated![/QUOTE]
Billing Manager
Answer:
So I can be clear - give me more information as to what you are trying to do..
But I think your asking if you do a pre op (yes - that is a consult) and you can add an office e&m visit with modifier 25 to it is it or. and yes it is. Just separate the dx pointer codes to the consult and the e&m visit. Hope this helps - Janice
Answer:
So I can be clear - give me more information as to what you are trying to do..
But I think your asking if you do a pre op (yes - that is a consult) and you can add an office e&m visit with modifier 25 to it is it or. and yes it is. Just separate the dx pointer codes to the consult and the e&m visit. Hope this helps - Janice
mitchellde
True Blue
You cannot charge two E&M visits for the same encounter. The only time that is acceptable is when you use a preventive E&M for an annual and an office visit for a problem. You can never charge a consult level and a new patient level, nor can you charge 2 new patient levels at the same encounter.