Wiki New Patient Medicare Denials

[jhendrix08]

I have received some denials from Medicare for New Patient office visits. The provider will use the appropriate CPT code for new patient and then the diagnosis code of Z76.89 (Persons encountering health services in other unspecified circumstances). Can anyone shed some light on how a New Patient office visit should be billed to Medicare?? (Original Medicare) *Note:these were truly new patients, so that was not the reason for the denial.

Thanks in advance!!

 

[mitchellde]

The denial is probably due to the diagnosis used is unspecified. Even if the patient is a new patient there should still be a documented chief complaint/reason for visit. If this is a new patient preventive exam then you need to use the preventive exam CPT code with the Z00.00. Without knowing the documented reason for the visit it is hard to advise further.