Bill 2 New Patient Visits

if a new patient (99202) comes in for a physical & then complains of(example)poison ivy, would we bill a new patient visit(99202) for the physical & a new patient visit(99202) for the poison ivy?

re: Bill 2 New Patient Visits

for a new patient visit that is coming in for a physical you should be using the age approiated preventive medicine codes in the range of 99382-99387 unless the patient has MCR. to bill an additional office visit the physician has to have seperate documentation to support the additonial visit and then you would use the 99201-99205 codes. You would also need to add a modifier 25 on the additional E&M to get it paid w/the DX other than V code for the type of Well visit that you bill. read the guidelines in the CPT® under the preventive medicine section to see if the visit consituties an additional E&M.

re: Bill 2 New Patient Visits

Many payers will only recognize one new patient code per encounter, so if you're utilizing the new patient physical exam 99384 - 99387 codes, you would use the established patient codes for the separate E&M service 99213 -99215 with modifier 25.

re: Bill 2 New Patient Visits

I'm sorry but that is incorrect, if the patient is being seen as a new patient for a Well visit and an additional E&M visit is done, you would still use the new patient E&M codes 99201-99205 as this is the initial visit, you cannot bill an new well visit with an establish visit code. I do this at the gyn practice that I work for and per the coding guidelines a patient is not estabilished until after the initial visit.

re: Bill 2 New Patient Visits

Hey if you get paid for billing 2 new codes within the same encounter, more power to you. Hence the reason I added "many payers" will not reimburse it. Also depends heavily upon what has been agreed upon in your contract.

re: Bill 2 New Patient Visits

My point being is not that we get paid for the additioanl E&M, you misread that incorrectly or maybe misunderstood, what i was trying to state is that you do not bill an new patient Well care E&M (99382-99387) with an established E&M (99211-99215) the additional E&M would also be a new visit. sorry if you took offense:)

re: Bill 2 New Patient Visits

I did not take offense, but I disagree with you. Only one visit can establish a new patient, not two. Thus, once the new patient physical /well woman exam has been completed the E&M portion of the visit is billed as established, because you are not performing a new patient re-assessment twice. We do bill New Well and Established E&M and get paid every time (supported by the documentation). At one time we were billing both as new patient codes and received denials. Clarification from the payer reiterated what I stated above.

re: Bill 2 New Patient Visits

If it is a sports physical, some payors allow the use of a different code to bill for this service. These are "added value service benefits". Otherwise you could use the preventive management codes and depending on the severity of the problem, you could also bill a 99202. Preventive codes allow for a minor problem to be addressed at the same encounter.