Forum - Questions & Answers

Aug 25th, 2016 - jmschuma 11 

can a new patient be billed as established

For a patient whose diagnosis requires only an EPF exam (but the history and MDM are more extensive), can I code it as an established patient instead (99214 instead of 99202)?

Aug 25th, 2016 - CT1450 1 

re: can a new patient be billed as established

No you need to bill out a new patient if it is a new patient. If the patient was referred to you by another physician; and, the insurance is not Medicare or Medicaid, then you can bill out a consult code. The other carriers are paying for consults.

Aug 25th, 2016 - jmschuma 11 

re: can a new patient be billed as established

Thanks. I had an audit on a hospital encounter where the physician did not include family or social history. The Novitas auditor down-coded from an initial hospital to a subsequent hospital. I didn't know if that was an acceptable practice for clinics.



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