You can post a question only up to 7 days from the date of the webinar.
You can continue to post comments and stay informed, compliant, and profitable.
Close
This session has expired.
Register for our upcoming webinars & continue to get coding, compliance & reimbursement updates.
Close

Post

Vote
0
0 Followers Follow
Posted By Lillian Boyanton on 07-22-2019, 10:55:52 in Ob-Gyn
Patient comes in for a NEW annual and a gyn problem is also addressed. Is this coded NEW/NEW or NEW/ESTABLISHED?
I was counseled it should be NEW/Established based that only one NEW code can be submitted even at the same encounter because the insurance will deny the new patient preventive visit and pay the new patient problem visit (because the new patient problem visit pays less). Then they have to put in a corrected claim and put in an established patient preventive visit code.

In the past I was educated to code NEW/NEW because the whole encounter is NEW and not until the next time the patient comes back she's considered Established.
Which is the correct way to code this?

Thank you.
Lillian
Comments (1)
Posted By Melanie Witt on 07-24-2019, 13:56:34
You are correct. If she is new at the time of the service, both codes are coded as a new patient encounter. You cannot fix coverage with coding. If your payer specifically states you can only bill one new E/M code per date of service, then you will have to abide by their rules, but generally they are referring to two things like 2 E/M problem visits on the same date of service (either at 2 different encounters - in which case you bill only 1 E/M for all the work if the visit is for the same problem, or a new and then established visit code if they were for 2 different unrelated reasons). When you bill the preventive and problem service at the same visit, you also have to make sure the problem visit has a modifier -25 to get it paid. I have seen many examples of polices that say only one new patient visit EXCEPT when the patient has a problem and preventive visit at the same encounter.
Do you want to remove this attachment from this post?
Yes No
Do you want to add this specialty to your selected specialty list?
Yes No
To comment, please register for any of our webinars. Click here to register for our upcoming webinars.
Close
This comment will be permanently deleted. Do you still want to continue?
Yes No
Do you want to remove this comment from this discussion?
Yes No
Do you want to block this user from participating in this discussion?
Yes No
Do you want to allow this user to participate in this discussion?
Yes No
This post will not be available for further discussion/comments if deleted. Do you still want to continue?
Yes No