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amottice

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Question: New patient comes in for yearly exam with pap. Patient also present to physician a problem visit with "xxx". New patient visit would be coded with the new preventative exam cpt accordingly, but would you also code the problem visit as a new patient E/M code (physician has documented for this additional problem visit in patient chart). Need opinion on this please... Thank you in advance!!!
 
Modifier 25 Definition:
Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure. Based on your description, I would bill a "new" patient preventive with "established" patient E&M for the separate services. If you bill both as new patient, the carrier will downcode to established, if not outright deny. Make sure your documentation supports the separate E&M services. And when ICD10 kicks in, you will not get paid for both preventive and "sick" services.
 
I don't disagree with coding the problem visit as established in this case although some carriers will accept 2 new visits on the same date, this blows my mind but whatever floats their boats I guess.

I am curious to your statement that once I-10 goes into effect this will no longer be a payable scenario. Can you please explain further and give references?

Thanks

Laura, CPC, CPMA, CEMC
 
Debra A. Mitchell, MSPH, CPC-H had mentioned this in a prior post, and I recall this in one of the many webinars and education I have been suffering through.....

"However ICD-10 CM code for the general preventive visit does not allow the assignment of signs and symptoms or other reported diagnosis. There is not way with ICD-10 CM to bill both.
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Maybe the issue is that two visits cannot be billed on the same claim??? I am going to another live seminar next week and will inquire on this....
 
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