Forum - Questions & Answers

Nov 16th, 2016 - dwhite90 1 

New patient without an exam

Is it correct to bill a new patient -office visit/consult- without an exam?? Would it be acceptable to downcode to established E/M or use info in the chart to formulate the exam?????
Thank you for your time,
Debra White

Nov 16th, 2016 - lisakay1957 11 

re: New patient without an exam

For a new patient exam it requires the 3 key components of all levels of the CPT® code from 99201-99205, the history, the exam and the MDM. The only other exception is if the visit was based on time. To use the visit based on time 50% of the encounter must of been spent counseling and or coordination of care to the patient and it must be documented in the medical record time in and time out. You cannot take info from the patients chart to formulate an exam. The provider either has to document that an exam was done or the criteria of time used for counseling.

You cannot use an established patient code 99211-99215 for a patient that has never been seen by your practice. I would suggest you ask the provider to append his documentation to meet the requirements of a NP exam or the visit cannot be billed.

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