Forum - Questions & Answers

Dec 13th, 2016 - Malkey

Using Modifier 25 with a new patient annual

If a provider bills the code for a new patient annual and wants to also bill an office visit with modifier 25, is the code for the office visit for a new patent or an established patient?

Dec 14th, 2016 - lisakay1957 11 

re: Using Modifier 25 with a new patient annual

It would still be in the range of a new patient. The patient is still considered new through out the complete visit, until he makes another appointment to come bakc and then he would be established. Just make sure that the provider has documented that there is a significant, separately Identifiable evaluation documented and that he needs to have a separate note for the other level of E&M. Also be sure that you do not use the DX code for the patient annual on the other level of E&M and that there is a different DX being used for the level of E&M. Per MCR's guidelines there are certain symptoms that are considered part of the patient annual. Especially for Well Woman annuals, for example if a patient is being seen for her annual and she has complaints of menopause, hot flashes, etc, MCR considers that part of the new patient annual. Go to the MCR website and look up the info for new patient annuals and their guidelines. Link provided below;

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