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
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• CPT Code 99202
• 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

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• Typical face-to-face time 30-44 minutes
• 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

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• Exam Comprehensive exam
• 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

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Clear the Confusion about New Patient CPT Code
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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.
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Clear the Confusion about New Patient CPT Code
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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. 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
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Clear the Confusion about New Patient CPT Code
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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
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.
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Clear the Confusion about New Patient CPT Code
Range
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. 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 like Medicare, Medicaid, and
commercial insurance companies in your area. Our
expertise in primary care billing ensures maximum
insurance
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Clear the Confusion about New Patient CPT Code
Range

• reimbursements while following compliance with
  regulatory requirements.
• To know more about our primary care billing
  services, email us at info_at_medicalbillersandcoder
  s.com or call us at 888-357-3226.
• FAQs
• What are the CPT codes for new patient visits?
• CPT codes for new patient visits in a physicians
  office typically range from 99201 to 99205. These
  codes are used to classify different levels of
  care based on time spent with the patient and the
  complexity of the visit.
• How do I determine the correct CPT code for a new
  patient visit?
• 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.

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Clear the Confusion about New Patient CPT Code
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• What is the key difference between new patient
  and established patient CPT codes?
• The key difference is that new patient codes are
  used when the patient has not received any
  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 who
  have been seen within that time frame.
• Why is it important to use the correct CPT code
  for new patient visits?
• Using the correct CPT code is essential for
  accurate billing and reimbursement. Incorrect
  coding can lead to claim denials, delays, or even
  audits, which could impact your revenue cycle and
  practice reputation.
• What are common challenges in coding for new
  patient visits?
• 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.

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Clear the Confusion about New Patient CPT Code
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• How can I ensure proper use of new patient CPT
  codes?
• 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.
• How can Medical Billers and Coders help with
  coding for new patient visits?
• 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.