Wiki New Pt physical billed with a new Pt office visit

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HMarean

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Can anyone tell me the guidlines for billing a new pt physical with a new pt office visit. I was always taught this was not allowed. That is is either one or the other. The compliance dept where I work is telling the Drs that this can be done. I haven't seen any claims paid for these. Please HELP ME!!!

Heather in Ma.
 
It can be done as long as there is enough documentation to support an E/M level AND the documentation for the physical. Usually, the problem portion is a lower level E/M. If you find a mod/high level of documentation, take another look at it. Don't forget to use a modifier for the E/M.
 
Agree with Cyndi - it can be done but difficult to carve out because you have still have to meet the requirements for the new patient exam in all 3 areas (history, exam and MDM) in addition to supporting a comprehensive preventive code - documentation needs to be good and you probably won't get a high level E/M in addition to the preventive when they are new and their intent was for preventive service.

It all comes back to how it was documented. So your compliance department is technically correct IF documentation supports - that is the key.

Hope that helps!
Christie Musser, CPC
 
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