Coding: Evaluation & Management FAQ
Use the Initial Hospital Visit codes (99221-99223). If you are the admitting physician, add the AI modifier to the code.
If no other provider of the same specialty in your practice has provided any face-to-face service to the patient in the last three years, you bill a New Patient visit (99201-99205). If the patient has been seen within the last three years, you bill an Established Patient visit (99211-99215). NOTE: Hepatology is not a separate specialty from Gastroenterology. Review information on Medicare specialty codes.
Each individual payor will have their own policy on the use of the Consultation codes. If you have not been notified, it is advised that you check with the payor prior to billing the Consultation codes.
Since the patient was seen within the last three years, you must bill for an Established Patient visit (99211-99215). This depends strictly on the timeframe of the last visit, not the patient presentation.
A visit prior to a screening colonoscopy for a healthy patient is not billable.
Yes. If the patient requires some intervention on the part of the gastroenterologist prior to the procedure, you can bill a New Patient or Established Patient visit, depending on whether the patient has received any face-to-face service by any provider of the same specialty in your office within the last three years.
No. New Patient visits must be billed under the nurse practitioner/physician assistant’s NPI/provider number unless the payor tells you otherwise in writing.
Yes. As long as you have a documented E/M service during which the decision was made to do the procedure, you can bill both the procedure and the visit with a 25 modifier on the visit. You will receive full payment for both services.