Coding Questions: Proper new patient billing and coding

Published: 2010-07-06 22:09:37
Author: Marty Kotlar | ChiroEco | March 2010

Q: I purchased an existing practice from a retiring chiropractor, and he said he has been billing CPT code 99203 on new patients for the past 15 years and never got in trouble. He recommended I bill the same for my new patient examinations, and I am considering it. What is the best way to justify billing my examinations with CPT code 99203?

A: Just because he never got in trouble doesn’t mean he was doing it correctly.

New patient evaluation and management (E/M) coding is divided into broad categories, such as office visits, hospital visits, and consultations. Most categories are further divided into two or more subcategories of E/M services, such as two subcategories of office visits (new patient and established patient) and two subcategories of hospital visits (initial and subsequent).

The levels of E/M services recognize seven components: History, examination, medical decision-making, counseling, coordination of care, nature of presenting problem, and time. Let’s go over the second component: the examination.

The examination

CPT code 99203 includes a detailed examination. A detailed, single-organ system examination should include at least 12 elements identified by a bullet within the system/body area(s) being examined according to the 1997 documentation guidelines on E/M services.

Elements identified by a bullet within the musculoskeletal system include:

• Constitutional: Measurement of any three of the following seven vital signs: 1) sitting or standing blood pressure, 2) supine blood pressure, 3) pulse rate and regularity, 4) respiration, 5) temperature, 6) height, and 7) weight (may be measured and recorded by ancillary staff).

• Appearance: General appearance of patient (for example, development, nutrition, body habitus, deformities, and attention to grooming).

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