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Pediatric Coding Alert

Reader Question:

Even 'Quick Assessment' Creates Established Patient Status

Question: Our pediatrician saw a newborn as a quick assessment within a few days of birth at no charge. The mother returned with the baby at two weeks for a complete exam. Should this be billed as an E/M service, and if so, should it be established or new? Missouri subscriber Answer: When the visit is a follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (eg, 99212-99215) and problem-specific diagnosis codes should be reported. The patient will be considered "established" because you already treated the patient during a face-to-face encounter within the last three years, which constitutes an established patient under the CPT guidelines. If no feeding or other significant health problem was previously noted, this visit may be the first well-child visit when provided by a physician, nurse practitioner or [...]