Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Billing medicare patient one time only per month

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.

Related Topics