Maximizing Reimbursement; New
Practice, Old Patients
Q & A that were
submitted to our Support HOTLINE
Q: I supervise a family medicine group that is trying to
maximize its billings. We have a few questions that might lead to additional
revenue:
Q1: We currently use the
following CPT codes for colposcopies: 57452, 57454, 57455, and 57456. We own
the equipment. Is there any other code that can be billed to cover the
equipment costs?
A1: The equipment costs are included in the practice expense
portion of the RVU. The procedure codes include this.
Q2: We have an autoclave for
sterilization of equipment and supplies. Is there any way to be reimbursed for
this or is it just part of practice expense?
A2: This is also part of the RVU practice expense component
as above.
Q3: If a patient comes into
office for a urine pregnancy test provided by a medical assistant, we currently
bill 81025. Is there any other code we should be using? Should we bill for a
Level 1 visit also?
A3: If the physician needs to "read" the test, and
he makes a note with the test results (that day), you can bill a 99211 in
addition to the lab. If a positive test leads to a full encounter with the
physician, the appropriate level of E&M can be billed.
Q4. Is there a billable CPT
for use of suture removal trays?
A4: A4550 is the code for surgical trays and the suture
removal materials appear to fall under that. This is not reimbursed by all
payers.
New Practice, Old
Patients
Q: I recently left a job working with an
urgent-care/family-practice center to work in a hospital-owned practice just a
few miles away. If I see patients at my new office that I previously saw at the
urgent-care facility I want to code them as new patients. Often, I am not aware
that patients saw me at the previous facility unless they inform me, especially
if I saw them for a minor, urgent problem and I did not really established a
relationship with them.
Further complicating
matters is that one of our other two providers might see the patient for the
first time, but I may have previously seen the patient at the urgent-care
facility.
Can we characterize these
patients as new? The urgent-care facility was privately owned by a local
physician; the new office is owned by a hospital system (they are two
completely different entities).
A: It’s good that you
pointed out the two facets of the issue as they have different answers. The CPT
book is quite clear that a new patient is one that has not received services
from a (particular) physician, or another physician in the same group (with the
same Tax ID) and with the same specialty or subspecialty within the last three
years.
So, if you are providing
services to a patient that you saw at your previous practice within the last
three years, you must bill the visit as an established patient, regardless of
the whether you previously saw the patient for a minor, major, or urgent problem.
When other providers at
your new practice treat a patient that you saw at the old practice, they do not
have to bill the patient as established as this patient does not meet the
conditions set out above.
FOR MORE INFORMATION PLEASE CONTACT:
HPP Management
Group, Corp.
Developers of the AccuChecker Product Line
305-227-2383
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