Clear the Confusion about New Patient CPT Code Range

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Clear the Confusion about New Patient CPT Code
Range
Defining New Patient According to the CPT
definition, a new patient is someone who 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 last three years. Differentiating
between new established patients and accurate
use of new patient CPT codes is important for
reimbursement purposes. Understanding the terms
professional services and group practice is
crucial in making this differentiation. As a
primary care physician, it can be challenging to
incorporate this definition into your coding
habits, but this article will explain why it
matters and will also share the new patient CPT
code range. New Patient CPT Code Range 99202
99205 The new patient CPT code range is used to
describe the initial visit with a healthcare
provider. These codes were last revised in the
year 2021 by the AMA to better reflect the level
of complexity and time required for a visit. The
new patient CPT code range is as follows CPT
Code 99202
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Clear the Confusion about New Patient CPT Code
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• 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
• History Expanded problem-focused history
• Exam Expanded problem-focused exam
• Medical decision-making Straightforward
  complexity
• Typical face-to-face time 15-29 minutes
• CPT Code 99203
• 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
• History Detailed history
• Exam Detailed exam
• Medical decision-making Low complexity
• Typical face-to-face time 30-44 minutes

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Clear the Confusion about New Patient CPT Code
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• CPT Code 99204
• 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
• History Comprehensive history
• Exam Comprehensive exam
• Medical decision-making Moderate complexity
• Typical face-to-face time 45-59 minutes
• CPT Code 99205
• 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
• History Comprehensive history
• Exam Comprehensive exam

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Clear the Confusion about New Patient CPT Code
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• Medical decision-making High complexity
• Typical face-to-face time 60-74 minutes
• Its important to note that CPT code selection is
  not just based on the typical face-to-face time
  alone, but also on the level of history, exam,
  and medical decision-making documented in the
  medical record. The typical face-to-face times
  listed here are just guidelines and should not be
  the sole factor in determining the accurate code
  from the new patient CPT code range. The time
  listed for each code is an average and can vary
  based on the complexity of the patients 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.
• New Patient vs. Established Patient
• Previously, distinguishing between new and
  established patients was simple. A new patient
  was someone who had not been seen before or did
  not have a current medical record. However, due
  to changes in healthcare delivery, this
  differentiation has become more complicated. As
  mentioned above, a new patient is someone who 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 last three
  years.

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Clear the Confusion about New Patient CPT Code
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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 code range (99211-99215)
requires only two of the three key components to
be met. 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. Defining Professional
Services and Group Practice Defining
Professional Services Professional Services
refer to those medical services that are 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). This definition is
important because it helps practices to determine
whether a patient is new or established, based on
whether the physician or provider has provided a
face-to-face service to that patient within the
last three years. If the physician or provider
has not provided a face-to-face service to the
patient within the last three years, then the
patient is considered a new patient and can be
billed using the appropriate code from the new
patient CPT code range.
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Clear the Confusion about New Patient CPT Code
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• Defining Group Practice
• Group Practice refers to a healthcare
  organization or facility where multiple
  healthcare providers work together, such as a
  medical group or clinic. In group practices, the
  definition of a new patient can be more complex
  than in solo practices because the patient may
  have seen another provider within the same group.
  The critical element in this scenario is the
  specialty designation of the healthcare provider.
  Suppose a patient has been receiving care from a
  pediatrician within your practice regularly. 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.
• How does new patient CPT code range impact your
  practice?
• 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 have an impact on your practice in
  several ways.
• First, the new codes may require you to adjust
  your documentation practices to ensure that you
  are accurately capturing the level of medical
  decision-making required for a visit. This may
  include updating your electronic health record
  (EHR) templates or training staff on the new
  codes and documentation requirements.

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Clear the Confusion about New Patient CPT Code
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• Second, the new codes may impact reimbursement
  rates for new patient visits. Insurance companies
  may adjust their reimbursement rates based on the
  level of complexity of the visit, which could
  result in higher or lower reimbursement rates for
  your practice.
• Finally, the new codes may impact patient
  satisfaction and retention. Patients may be more
  likely to return to a provider who takes the time
  to thoroughly assess their medical history and
  develop a comprehensive treatment plan. By
  accurately capturing the complexity of the visit
  with the new CPT codes, you can demonstrate to
  patients that you are providing high-quality
  care.
• In conclusion, the new patient CPT code range is
  an important update for primary care providers.
  By accurately reflecting the level of 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. As a
  primary care provider, its important to stay
  up-to-date on coding changes to ensure that your
  practice is providing high-quality care and
  maximizing revenue opportunities.
• In case you find it difficult to accurately use
  the new patient CPT code, we can assist
  you. Medical Billers and Coders (MBC) is a
  leading revenue cycle management company
  providing complete medical billing and coding
  services. We can assist you in the accurate
  selection of CPT codes as per the insurance
  companys guidelines. We take complete ownership
  for accurate claim submissions for all major
  insurance companies

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Clear the Confusion about New Patient CPT Code
Range
like Medicare, Medicaid, and commercial insurance
companies in your area. Our expertise in primary
care billing ensures maximum insurance
reimbursements while following compliance with
regulatory requirements. To know more about our
primary care billing services, email us
at info_at_medicalbillersandcoders.com or call us
at 888-357-3226.