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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.
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.
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