Wiki New to Est missing Components

[krystim1109]

When you have a new patient who doesnt meet the 3 of 3 requirement for the selected E/M, can I donwcode the record to established patient? I want to say no, but some coworkers disagree.

 

[tmlbwells]

If it's a new patient, never before seen in the practice, they have to be coded as one. You can't make them an established patient if they aren't. I think that would be an example of downcoding and would make it fraudulent and open your office up to audit problems.

I hope this helps,
Mary Wells, CPC, RCC

 

[teresabug]

The visit simply is not billable.

Downcoding is just as wrong as upcoding.

Your co-workers are incorrect.