Your Complete Guide to New Patient CPT Codes

Your Complete Guide to New Patient CPT Codes

Tackling medical billing efficiently is the game of mastering CPT (Current Procedural Terminology) codes. It is the foolproof way to avoid errors and denials in the medical billing process of any specialty.  

When it comes to codes, new patient CPT codes are scarcely mentioned. Lack of adept understanding of the new patient codes lead to errors and denials. This brings attention to prioritizing these types of codes and optimizing the revenue cycle management process. 

In this blog, we will explore the concept of new patient CPT codes and learn how healthcare providers can navigate complex CPT codes.  

Introduction of New Patient CPT Codes   

The explanation of this concept lies in the name itself. New patient CPT codes denote a patient receiving medical services for the first time from a particular healthcare practice or a provider. However, there are some terms and conditions to this, and they are: 

A new patient must not have received medical services from a healthcare provider of the same medical specialty.  

The period for not receiving services must be three years.  

A patient who has not received healthcare services from the physician in the last three years is known as a new patient. CPT codes used to determine such patients are called new patient CPT codes.  

On the contrary are the established patient CPT codes and they are meant to define patients who have received medical services in the last three years.  

Skillfully distinguishing between a new patient and an established patient is vital to ensuring a robust revenue cycle. Ensuring accurate patient codes is essential to managing the administrative tasks efficiently and attaining adequate revenue. 

Let’s go through the code range and gain more knowledge of this topic! 

Understanding the Range of New Patient CPT Codes   

The new patient CPT codes range from 99202 to 99205, and we will go through these in this section. 

The CPT code range explains the initial patient visit, and it was recently updated in the year 2021 under AMA guidelines. Every code defines different levels of healthcare complexities.  

Here is the list of CPT code ranges: 

99202 

  • This code is used for a level 2 new patient visit  
  • Demands a low level of medical intervention  
  • The time of visit extends to 20 minutes (Ranges from 15-29 minutes) 
  • Medical history is problem specific and includes the patient's condition 
  • Includes problem specific medical examination and comprehensive evaluation  

99203 

  • This code is used for a level 3 new patient visit 
  • Demands a moderate level of medical intervention  
  • The time of visit extends to 30 minutes (Ranges from 30-44 minutes)  
  • Includes detailed medical history of the patient  
  • Includes detailed medical examination to analyze the current situation 

99204 

  • This code is used for a level 4 new patient visit
  • Demands a high level of medical intervention 
  • The time of visit extends to 45 minutes (Ranges from 45-59 minutes)
  • Includes a comprehensive review of the past and present condition of the patient
  • Includes a comprehensive medical examination to determine the medical issue 

99205  

  • This code is used for a level 5 new patient visit
  • Demands a comprehensive level of medical intervention  
  • The time of visit extends to 60 minutes (Ranges from 60-74 minutes)
  • Includes a comprehensive review of the past and present condition of the patient
  • Includes a comprehensive medical examination to determine the medical issue

While selecting the CPT codes, all the above-mentioned factors under each code must exist. Only a single factor, such as time, cannot determine the CPT code; it must meet all criteria.    

Distinguishing New Patient from Established Patient  

We discussed in the first segment that a new patient is someone who has not received services from a medical specialty or a group within the last three years. On the other hand, this criterion is not the same for an established patient.  

There is more to the distinction between a new patient and an established patient, and that is:  

  • A new patient must meet all mentioned components, such as medical history, examination, and healthcare judgment
  • However, an established patient only needs to meet two or three components of the code range (99211-99215). 

The coding requirements for a new patient are more rigid in comparison to an established patient. This is the major difference between two types of patients, and this impacts the coding process too.  

There are two more concepts that play a significant role in the coding process for a new patient. In the above definition, two terms are mentioned, professional service and group practice. 

Let’s get to know these two concepts and understand their role in the new patient CPT codes! 

Explaining Professional Services and Group Practice  

Professional Services  

These healthcare services are provided by a healthcare provider, doctor, or physician. Specific CPT codes define professional services based on some vital phrases, such as face-to-face and reported by a specific CPT code.   

Understanding this term is important to continue the coding process for a new patient. It also helps in distinguishing a new patient from an established patient. If the physicians have rendered face-to-face medical services to a patient within the last three years, the patient is established, and if not, the patient is new.   

Group Practice  

A group practice refers to a medical facility where multiple healthcare providers render medical services based on their specialty. It is more difficult to define a new patient within a group practice as the patient may have received treatment from any other physician.  

If a patient has been receiving treatment from a healthcare provider for a long time for an ailment. The next time that patient goes to another healthcare provider and receives treatment for a different ailment, the patient will be considered a new patient.   

Impact of New Patient CPT Codes on Healthcare Practice  

The new patient CPT codes are supposed to reduce the medical billing complexity and simplify rendered services. However, healthcare providers may have to incorporate new methods to handle coding for a new patient.  

Here are some changes that healthcare providers and medical groups may have to make: 

Modifications in Documentation  

Healthcare providers must optimize their documentation process to capture accurate new patient CPT codes. Their process must include all the factors, such as history, examination, and medical decision.   

If the healthcare provider or medical group makes changes in their EHR system, that will be even more beneficial for revenue cycle management.    

Adjustments in Reimbursement  

The introduction of new patient codes in healthcare practice can alter the reimbursement rates. These changes may be from the insurance company due to the complexity of the new patient CPT codes. Healthcare providers must keep this in mind while carrying out the medical billing process.    

Patient Satisfaction and Retention  

Extending time to new patient CPT codes can hamper the level of patient satisfaction and retention rates. This happens as healthcare providers may need to spend more time dealing with medical coding than rendering quality patient care.   

To solve this issue healthcare providers can shift their administrative burden to professional medical billing services. This way they can save their time and devote the same to improving the quality of patient care.  

Final Thoughts  

The new patient CPT codes are as important as any other CPT codes. However, healthcare providers may face difficulty understanding the basics and implementing this in their medical billing process. To counter the complexities, outsourcing is the ideal option for healthcare providers and practices.   

Medical billing services stay current with necessary coding changes and incorporate the same in the process effortlessly. Their experience in dealing with multiple healthcare providers makes them the perfect solution to solve this issue.   

Eminence RCM is one such medical billing partner that is proficient in navigating through new patient CPT codes and claim filing. Our team of qualified professionals ensures accuracy and efficiency in every medical billing step. We make sure that your healthcare practice always meets compliance requirements and submission deadlines.   

With our proficient services, your healthcare practice can achieve robust revenue and optimize the workflow.   

Schedule Demo