We are a new Dermatology office and my PA has been in the area for 6 years. When she bills Medicare, they are denying new pt. E&M codes because she has seen the pt. within the last 3 years at her previous office.
Has anyone else ran into this yet? I spent plenty of time talking to Medicare and they say:
Medicare 100-4 Chapter 12 Section 30.6.7
A Definition of New Patient for Selection of E/M Visit Code
Interpret the phrase ?new patient? to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.
We have no idea when the last time she saw each pt. without looking at every single one of their records before/during the visit. The only way to do this is to submit the claim with a New Pt. code and if it denies then change it. My problem with that is... Since all of these patients are new chart wise we are taking full history, full ROS, which could potentially "upcode" a 99213 to a 99214. < I expressed this to the Medicare rep. and they agreed with me, but this is the rule/edit.
Can anyone please help with this issue?
Has anyone else ran into this yet? I spent plenty of time talking to Medicare and they say:
Medicare 100-4 Chapter 12 Section 30.6.7
A Definition of New Patient for Selection of E/M Visit Code
Interpret the phrase ?new patient? to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.
We have no idea when the last time she saw each pt. without looking at every single one of their records before/during the visit. The only way to do this is to submit the claim with a New Pt. code and if it denies then change it. My problem with that is... Since all of these patients are new chart wise we are taking full history, full ROS, which could potentially "upcode" a 99213 to a 99214. < I expressed this to the Medicare rep. and they agreed with me, but this is the rule/edit.
Can anyone please help with this issue?