99215 & 99203

[TXBiller]

Hi All

Need some help please.  I'm still new and going through AAPC training.  Hoping to be certified soon.

How would I accurately code the following? Would this be correct and in this order?

All well documented in chart. 

99203 Est New PCP
99215 visit was 60 minutes  Mod 25
93000 EKG
G0444 Annual depression screening  Mod 59

I read a lengthy article but still confused.

Thank you

[kristin]

You can't code both a 99203 and a 99215 at the same time. Either the patient is new, and you code the 99203, or they are established, and code the 99215. Either way, it gets the 25 modifier. The 93000 is fine, as is the G0444, which should NOT need a 59 modifier, although some insurances like Humana MA want it there.

[TXBiller]

He's a new patient and took up 60 minutes of the physician's time.  long story.  : /

[Michele]

If he's a new patient that took 60 minutes of the drs time it still would only warrant one E&M code of 99201-99205.  Time is not the only deciding factor but it sounds like you are indicating that it may have been a high level of complexity which might warrant the 99205.

99205  -   OFFICE/OUTPATIENT VISIT NEW for the evaluation and management of a new patient which requires these 3 key components:  A comprehensive history; A comprehensive examination; Medical decision making of high complexity; Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provide consistent with the nature of the problem and the patient's and/or family's needs.  Typically 60 minutes are spent face to face with the patient and/or family.

The 99215 code is for established patient and wouldn't be appropriate.