Can We Bill a New Patient Visit for Preventive and E/M Services on the Same Day?

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Question:

Our physician saw a patient and did a preventive medicine service and addressed an acute, significant problem. The patient was new to us. Should we bill both as new patient visits?

Answer:

The last time I saw this addressed by CPT® was in the October 2006 CPT Assistant. If anyone has seen anything since, let me know.  CPT® is asked this very question and their answer is to bill both as new patient visits.

“Therefore, if a preventive medicine service and an office or other outpatient service are each provided during the same patient encounter, then it is appropriate to report both E/M services as new patient codes (ie, 99381-99387 and 99201-99205, as appropriate), provided the patient meets the requirements of a new patient based upon the previously noted guidelines.”

We look to CPT® to answer coding questions. However, from a reimbursement perspective, I think it is likely that a payer will only allow one new patient visit/patient and will deny the second new patient visit.  Different payers may process this differently, depending on the edits set up in their systems.

So, from a coding perspective, yes, both should be new. From a reimbursement perspective? I’m not so sure. I think the payer will deny two new patient visits by the same practice/specialty on the same date of service. I suspect their system will have an edit for it. But, it follows coding rules to do this, and you can show them the CPT reference on appeal.

Frustrating, I know, to follow coding rules only to have payers follow their own reimbursement rules.