tci E/M Coding Alert - 2020 Issue Q4

Reader Questions: Beware of Assigning E/M in This New Patient Encounter

Question: Can we bill 99201-99205 for a patient who comes in to establish care with our pediatrician? The patient is new to our practice and is healthy, with no signs, symptoms, or problems of any kind. Arizona Subscriber Answer: If the patient has no condition for your provider to evaluate or manage, you cannot bill a new patient E/M code using 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient …). That’s because establishing care does not support medical necessity for the service. For this kind of visit, you essentially have...

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