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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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Can we bill a new patient visit for preventive and E/M services on the same day?

  • See our on-demand webinar, Preventive medicine and Medicare wellness visits with an E/M.

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.


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Last revised February 1, 2022 - Betsy Nicoletti
Tags: Preventive and problem visits

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Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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