By recei Evaluation and management (E/M) The healthcare providers report E/M codes often on medical claims.
New Patient – A new patient is the one who visits to take a service for the first time or one who has not received professional services from a physician of same physician group practice within the previous three years.
99201: If the history is problem focused, and decision of treatment is straightforward in nature.
99202: If the history is Expanded problem focused and decision of treatment is straightforward in nature.
99203: If the history is detailed and decision of treatment is of low complex in nature.
99204: If the history is comprehensive and decision of treatment is of moderately complex in nature.
99205: If the history is comprehensive and and decision of treatment is of Highly complex in nature.
Note: 99201 is no longer in use to bill E/M due to conflict between 99201 and 99202.
Established Patient – An established patient is one who has taken professional services from a physician or other qualified health care professional of the same specialty who belongs to the same group practice, within the past three years”.
Established Patient Codes – 99211, 99212, 99213, 99214, 99215
- Always check the patient’s past visit to healthcare providers’ office in the PMS to identify if a patient is established or new patient.
- Call to insurance or check payers’ website to understand the real reason for denial because sometimes the EOB you might have received does not provide exact reason for denial or software that you are using might not be updated with the past history of the patient.
- Remember we can always ask the rep to send the claim back for reprocessing if the denial is incorrect.
- Always take help of the coding team if it is found that CPT need to be corrected.
Also read:
Precertification or Authorization Absent