Forum - Questions & Answers
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?
re: New patient elements missing
yes
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
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?
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.
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