Forum - Questions & Answers

Sep 10th, 2015 - lmckenna 19 

New patient elements missing

Is it true that if the provider doesn't hit the required 3 elements for a new patient E/M that we can still bill the visit but it would be billed with an est'd pt E/M?

Sep 11th, 2015 -

re: New patient elements missing

yes

Sep 11th, 2015 - lmckenna 19 

re: New patient elements missing

Thank you signaturedoc but, I am getting conflicting answers. CMS states we can do this for hospital visits. An auditor I know says we cannot for office visits.
Can you tell me where I might find this guideline for office visits? Thank you

Sep 11th, 2015 -

e: New patient elements missing

Well, you got me there- I was "extrapolating" from the guidance on hospital visits. Could they possibly want a doc to use a new patient code when all elements are not met?

Sep 11th, 2015 - lmckenna 19 

re: e: New patient elements missing

No problem. From what another auditor has told me, if the office documentation doesn't reach even a 99201 then we would bill nothing at all. Since all 3 elements are required for NP's, the provider would loose the RVU's and insurance refunded. We learn something new everyday on this blog eh? Thanks for your time.

Sep 11th, 2015 -

re: e: New patient elements missing

That seems wrong to get nothing at all. I'd ask that person for a citation that says you can't use established codes for a new patient. Turn it around on them



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