Q. A patient with Medicare as his primary insurance needs a physical and EKG for clearance for an MRI with sedation ordered by his neurologist. Symptoms are imbalance along with pain in the shoulder, neck, and upper spine. Can I use the pre-op code V72.81 because there is sedation even though there is no actual surgery? Or should I just get a signed Advanced Beneficiary Notice (ABN) and expect a denial? A. Yes, you can …
Read MoreAn Update on New vs. Established Patients
David Stern, MD Q.I read your column about new vs. established patient coding in the January Issue of JUCM. Although the information provided was correct at one time, I believe that Medicare has updated its algorithm to come closer to the algorithm provided by AMA for new vs, established patients. A.You are correct. In a somewhat obscure and rarely referenced information release. (www.cms.hhs.gov/MLNMattersArticles/downloads/MM4032.pdf) CMS did change its position on this issue. “Physicians should not that …
Read MoreDetermining New vs. Established Patients for E/M Coding
Q.We are in the process of adding urgent care services to our occupational medicine clinic. How do we determine when to use a new or established E/M code for the patients who are seen for urgent care services? A.I continue to receive questions regarding the “when to code new or established patient E&M codes” conundrum, so let’s try to simplify the issue. The official CPT definition of new patient is: A patient who has not …
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