Coding and Documentation
Answers to Your Questions
Fam Pract Manag. 1999 Feb;6(2):23-24.
- Differentiating between new patients ...
- ... and established patients
- Coding repeat procedures
- Codes for motor vehicle accidents
- Discharging hospitalized patients
- When preventive visits get complicated
Differentiating between new patients ...
I recently saw a patient for the first time, although she had been seen a few months ago by one of the ob-gyns in our group. Was I correct in coding my encounter with the patient as a new-patient visit?
Yes. CPT defines a new patient as “one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the last three years” (emphasis added). Had the patient been seen by another family physician in your group, however, she would have been considered an established patient in her encounter with you.
... and established patients
I recently cared for a new patient during a three-day hospital stay. After being discharged, the patient came to our office for the first time. Should I have coded the hospital services as new-patient encounters? What about the first-time office visit?
The hospital inpatient services codes aren't distinguished by the patient's status as new or established. Assuming that the patient came to your office within three years of being discharged from the hospital, you should have coded that encounter using the appropriate code for an established-patient office visit, since a physician of the same specialty who belongs to your group (in this case, you) had provided professional services to that patient within the past three years.
Coding repeat procedures
If I provide the same lab service to a patient in the morning and again later that afternoon, how can I distinguish the second service from the first on the claim?
Use modifier -76 with the second service to indicate that it was a repeat procedure by the same physician.
Codes for motor vehicle accidents
What ICD-9 code should I use to indicate that I provided services to a patient who had been involved in a motor-vehicle accident?
Try a code in the range E810-E825. Note that whichever code you choose will need a fourth digit to make the report of the injury more specific. This code should be used secondarily to the code for the patient's condition (such as 920 for a facial contusion).
Discharging hospitalized patients
If I discharge a patient from the hospital to a nursing home, should I bill only for discharge from the hospital or for discharge from the hospital and admission to the nursing home?
According to CPT, “Hospital discharge or observation discharge services performed on the same date of nursing facility admission or readmission may be reported separately.” So yes, you should bill for the hospital discharge and the nursing home admission.
When preventive visits get complicated
How should I code a visit that is primarily preventive? Would that coding change if the patient also has some symptoms or another diagnosis?
Generally, you should code visits that are primarily preventive using one of the preventive medicine services codes mentioned above. The correct code is based on the patient's age and whether the patient is new or established. According to CPT, if you encounter an abnormality or address a pre-existing problem while performing a preventive medicine evaluation and management (E/M) service, and “if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service,” then you would also report the appropriate office-visit code (99201–99215). But be sure to add modifier -25 to the office-visit code to indicate that you provided a “significant, separately identifiable” E/M service on the same date as the preventive medicine service.
Editor's note: While this department represents our best efforts to provide accurate information and useful advice, we can't guarantee that third-party payers will accept the coding and documentation recommended. For more detailed information, refer to the current CPT manual and the “Documentation Guidelines for Evaluation and Management Services.”
Copyright © 1999 by the American Academy of Family Physicians.
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