Paula Posted Thu 25th of February, 2010 15:48:27 PM
Is it documented anywhere that you can only bill a Medicare pt one time per month for an office visit for same diagnosis
Alan Answered Fri 26th of February, 2010 08:44:49 AM
Office visits are differentiated as "new" and "established" patient encounters. In case of new patient visit (whatever be the diagnosis) the code 99201 - 99205 can be coded only once in 3 years, as per E&M office visit coding rules. In case of "established patient", codes 99211-99215 can be billed and there is no time or encounter limit for coding that. As far as I know, there is no rule regarding "coding office visits once per month for same diagnosis".
Melanie Answered Tue 23rd of March, 2010 13:47:48 PM
I agree with Alan - you are gonna run into Medicare patients who are receiving monitoring-level care for chronic conditions that might require additional visits...
As always, keep good records and should Medicare decide to ask for records - they will send the formal request...
They did on one of our patients and it was billed with a 99213... so as long as you have good up-to-date history/records on the patient(s), you will be fine.