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billing new pt e&m

Renee Posted Wed 20th of November, 2013 10:48:13 AM

one of my providers is asking about billing a new pt e&m code for a patient. this patient has not previously had insurance coverage, most of the charges for his visits have been adjusted/reduced. he now has insurance coverage and my dr. wants to bill a new pt. e&m code. my initial reaction is that we can NOT bill new pt code, as pt has been seen by provider in the last 3years. i need some black&white documentation to support/refute this statement to my provider. any help will be greatly appreciated. thank you! melissa

SuperCoder Answered Wed 20th of November, 2013 20:39:14 PM

Your physician must bill an established patient visit as the patient has been seen by him in the last 3 years.
CPT book, page 4 explains how to code for new and established patients. If he bills this patient now as a new patient, he will fail an outside audit.

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