I am writing this article because I have found that providers are forgetting about the new patient visit that can be reported if a patient has not been seen in 3 calendar years. The reason I bring this up is because clearly there is more work involved in terms of updating the full record if a patient hasn’t been seen in such a long time. With that comes additional revenue when billing for the new patient codes.
The new patient problem focused codes are 9901-99205, and new patient preventative codes are 99384-99387. Then comes the question, what if the patient booked preventative and also receives problem focused care at the same visit? CPT states you can report a preventive and a problem oriented visit assuming all guidelines have been met. So BOTH of these new patient visit codes can be used at the same encounter if appropriate. But…don’t forget to use the 25 modifier on the problem focused visit code which tells the insurance company that this was a significant and separately identifiable E&M service on the same day of another service.
There are carriers that will pay for both of them, however, not all carriers will pay for both, some will want an existing patient code 99211-99215, and will state two new patient codes not allowed in the 3 year time frame. In all cases you should verify with your local carrier and you should always document both services provided, including time spent, separately in the record to make it clear that separate services were indeed provided.
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