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As mentioned above, a new patient has not received professional services from the physician or another physician in the same specialty and group practice within the last three years, while an established patient has received such services within the previous three years.

‘Professional Services’ refer to those medical services provided by a physician or qualified healthcare provider in person and reported by a specific CPT code. The key phrases are ‘face-to-face’ and ‘reported by a specific CPT code(s).’

Are you having trouble using the correct New Patient CPT Code Range? Let Medical Billers and Coders (MBC) help! We offer comprehensive billing services to ensure accurate code selection, proper claim submission, and maximum insurance reimbursements.

This code describes a level 5 new patient visit that requires a comprehensive level of medical decision-making. The typical time for this visit is 60 minutes. Documentation requirements for new patient CPT code 99205 are as follows:

As a primary care provider, staying up-to-date on coding changes is essential to ensure that your practice provides high-quality care and maximizes revenue opportunities.

Medical Billers and Coders (MBC) can assist you by providing expertise in medical coding and billing, ensuring compliance with coding standards, and reducing errors in claims submission. We offer services to streamline your revenue cycle and minimize the risks of coding errors or claim denials.

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The typical face-to-face times listed here are guidelines and should not be the sole factor in determining the accurate code from the new patient CPT code range.

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This code describes a level 4 new patient visit that requires a high level of medical decision-making. The typical time for this visit is 45 minutes. Documentation requirements for new patient CPT code 99204 are as follows:

You can ensure proper use of CPT codes by keeping up-to-date with the latest coding guidelines, training staff regularly, and consulting with billing experts like Medical Billers and Coders. We can help you navigate coding complexities and ensure your claims are submitted accurately.

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It’s important to note that CPT code selection is not just based on the typical face-to-face time alone but also the level of history, exam, and medical decision-making documented in the medical record.

Since the requirements for coding problem-oriented new patient visits are more rigorous, there may be instances where the same service components would result in an established patient code with more RVUs than the appropriate new patient code.

Common challenges include determining the correct level of complexity, distinguishing between new and established patients, and ensuring proper documentation to support the selected code. Inconsistencies can lead to billing errors or compliance issues.

The time listed for each code is an average and can vary based on the complexity of the patient’s medical history, the number of complaints or symptoms, and other factors. Providers should use their clinical judgment to determine the appropriate code based on the level of medical decision-making required.

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The critical difference is that new patient codes are used when the patient has not received professional services from the physician or another physician of the same specialty within the same group practice in the last three years. Established patient codes are used for those seen within that time frame.

‘Group Practice’ refers to a healthcare organization or facility where multiple healthcare providers work together, such as a medical group or clinic. The definition of a ‘new patient’ in group practices can be more complex than in solo practices because the patient may have seen another provider within the same group.

This code describes a level 2 new patient visit that requires a low level of medical decision-making. The typical time for this visit is 20 minutes. Documentation requirements for new patient CPT code 99202 are as follows:

We can assist you in accurately selecting CPT codes according to the insurance company’s guidelines. We own accurate claim submissions for all major insurance companies, including Medicare, Medicaid, and commercial insurance companies in your area.

We can assist if you find it challenging to use the new patient CPT code accurately. Medical Billers and Coders (MBC) is a leading revenue cycle management company providing complete medical billing and coding services.

Our expertise in primary care billing ensures maximum insurance reimbursements while following compliance with regulatory requirements.

Understanding the terms ‘professional services’ and ‘group practice’ is crucial in this differentiation. As a primary care physician, it can be challenging to incorporate this definition into your coding habits, but this blog will explain why it matters and will also share the new patient CPT code range.

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The new patient CPT code range aims to more accurately reflect the complexity of the visit and the amount of time required to complete it. This can impact your practice in several ways.

Previously, distinguishing between new and established patients was simple. A new patient had not been seen or had no current medical record. However, this differentiation has become more complicated due to changes in healthcare delivery.

CPT codes for new patient visits in a physician’s office typically range from 99201 to 99205. These codes classify different levels of care based on the time spent with the patient and the complexity of the visit.

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To determine the correct CPT code, you need to consider the extent of the history taken, the complexity of the examination, and the level of medical decision-making involved. CPT 99201 is for minimal issues, while 99205 represents complex or lengthy visits.

In conclusion, the new patient CPT code range is an essential update for primary care providers. By accurately reflecting the complexity and time required for the initial visit, these codes can help providers better document their services, improve reimbursement rates, and enhance patient satisfaction and retention.

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. We are crucial in supporting physicians with precise and streamlined medical billing services.

If the physician or provider has not provided a face-to-face service to the patient within the last three years, the patient is considered a new patient and can be billed using the appropriate code from the new patient CPT code range.

Differentiating between new & established patients and accurately using new patient CPT codes is essential for reimbursement.

Using the correct CPT code is essential for accurate billing and reimbursement. Incorrect coding can lead to claim denials, delays, or audits, impacting your revenue cycle and practice reputation.

The new patient CPT code range describes the initial visit with a healthcare provider. These codes were last revised in 2021 by the AMA to reflect better the complexity and time required for a visit. The new patient CPT code range is as follows:

According to the CPT definition, a new patient has not received professional services from the physician or another physician in the same specialty and group practice within the last three years. Accurate differentiation between new and established patients, alongside the correct usage of the New Patient CPT Code Range, is critical for proper reimbursement and compliance with coding guidelines.

This definition is crucial because it helps practices determine whether a patient is new or established based on whether the physician or provider has provided face-to-face service to that patient within the last three years.

The critical element in this scenario is the healthcare provider’s specialty designation. Suppose a patient regularly receives care from a pediatrician within your practice. If the patient reaches the age of 18 and decides to transfer care to a family physician within the same practice, they would be considered a new patient.

Another important distinction between the new patient and established patient codes is that the new patient code range (99202-99205) mandates all three key components (history, examination, and medical decision-making) to be met, whereas the established Patient CPT Code Range (99211-99215) requires only two of the three key components to be met.

This code describes a level 3 new patient visit that requires a moderate level of medical decision-making. The typical time for this visit is 30 minutes. Documentation requirements for new patient CPT code 99203 are as follows: