new pt physical code/E&M code

If a new pt comes to see a doctor for a physical and the doctor sees them for something unrelated to the physical (toe injury) can they charge new pt codes for both the physical and the E&M or which one should they use as the "new" pt code

bill it...

new patient preventative based on age, E&M- established based on complexity. be sure documentation separates the two especially in the impresssion and plans

Problem focused E/M or preventive

If only it were cut and dry! (Is that the expression?)

Be careful billing two services: Medicaid will select the lower of the two.

For commercials: I agree, add detail to the HPI and Assessment and Plan to bill for both.

Payers have varying policies about whether they pay for both in a single day. Some require a second note.

Preventive and Problem E/M

[new patient preventative based on age, E&M- established based on complexity. be sure documentation separates the two especially in the impresssion and plans]

Actually, according to CPT Assistant Oct 2006, it instructs to bill both services as new patient.............



"Question: If a preventive medicine service (99381-99397) and an office or other outpatient service (99201-99215) are each provided during the same patient encounter to a new patient, is it appropriate to report each evaluation and management (E/M) service as a new patient visit? Or is it appropriate to report the preventive medicine service as a new patient and the acute visit (ie, office or other outpatient service, 99201-99215) as an established patient?

AMA Comment:It is important to first take careful note of the New and Established Patient instructions provided in the E/M services guidelines of CPT 2006 (page 1). Specifically, the guidelines state:

Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.

Therefore, if a preventive medicine service and an office or other outpatient service are each provided during the same patient encounter, then it is appropriate to report both E/M services as new patient codes (ie, 99381-99387 and 99201-99205, as appropriate), provided the patient meets the requirements of a new patient based upon the previously noted guidelines."

Also per CPT Assistant July 2009, if you're going to charge for both types of visits the problem needs to be "significant" and actually require work above and beyond what you are doing for the "COMPREHENSIVE preventive medicine" visit............



"The guidelines specifically instruct users how to report situations in which an abnormality is encountered or a preexisting problem is addressed during a preventive medicine E/M service. If the problem is significant enough to require additional work for the physician to perform the key components of a problem-oriented E/M service, the appropriate office/outpatient code (99201-99215) should be reported, in addition to the appropriate code for the preventive medicine E/M service, and modifier 25 should be added to the office/outpatient code. Appending modifier 25 indicates that a significant, separately identifiable E/M service (above and beyond the preventive medicine E/M service) was provided by the same physician on the same day as the preventive medicine service.

In order for the two E/M services to be reported on the same day, the problem or abnormality encountered must require additional work, and the performance of the key components of a problem-oriented service outside of the health supervision work inherent in the preventive medicine E/M service. If a physician encounters an insignificant or trivial problem/abnormality in the process of performing the preventive medicine E/M service, which requires neither significant additional work nor the performance of the key components of a problem-oriented service, it would be inappropriate to report the problem-oriented service, in addition to the preventive medicine E/M services."


"