Wiki New Patient Physial and New Patient Office Visit

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vannessam

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We are a pediatric office and occasionally a new patient is scheduled for a well visit physical and for example may have a rash as well. Can I charge an New well visit physical and NEW office visit for the same patient on the same day?
 
You would code this as: 9938X depending on the age of the child because this is a preventive medicine service (physical, new patient) and then 9920X depending on the level of the time it took for the rash. Make sure you put a modifier -25 on the 9920X CPT code as it was not the reason for the visit and is a separately identifiable service.
 
To clarify, modifier -25 will ALWAYS go on the 992XX CPT code, even if it or isn't the reason for the visit. The reason for the visit will depend on which CPT code made primary only. Also, put the rash as the 1st code on the 9920X CPT code and the V code 1st on the 9938X code. Hope this helps!
 
Expect a denial of one or both "New" patient codes...if you are lucky, they will pay one as "new" and the other as "established." I used to successfully argue with lots of documentation on appeal for insurance to cover one of the two codes as a "new" patient, but they would never pay both as "new"...and usually they would deem the well visit as the "new" code since they paid the same amount for any well visit.
 
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