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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Denied 99205
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Post Denied 99205
Author: DharmaDoc
Date: Jul 12, 2010 8:00 am
I am a hospital employee. A patient was referred to me for consultation by a specialist who is not an employee of the hospital. I spent a long time with this complex patient, and billed at 99205. The claim was denied and now my billing office is saying that if a patient is seen by ANY other employee of the hospital in the last three years, I cannot bill a consult, because she is not a new patient. Can this be true? They recommended using 99215. Is there a large dollar difference here? Thank you.
Replies: order by [Date] [Author] [Subject]
Re:Denied 99205 (by JulieP on 07/12/2010)
If the non hospital requesting specialist is not in the same SPECIALTY GROUP practice now or within the last 3 years and no one else in the same specialty group practice saw this patient within 3 years, the patient is new. You should ask them who else with your specialty saw the patient within the last three years.

Julie Pipke-CPC, CAPC Consultant
Re:Denied 99205 (by ehrbiller on 07/28/2010)
This depends on the specialty as well. If yourself and the other physician are in completely different specialties then you are absolutely correct in using 99205 (new patient). However, if it is the same speciality or subspeciality i.e. pediatric vs. pediatric dermatologist, then you must use the established codes i.e. 99215. Your billers can consult pgs. 4 and 5 of the AMA CPT manual for further assistance. I hope this helps your office.

Felicia Copeny, CPC

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