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CERT Spotlight: New Patient Office Visits
In the May 2006 Comprehensive Error Rate Testing (CERT) report the CERT contractor, AdvanceMed, reported a 15.9 % paid claims error rate for new patient office visits, CPT Codes 99201 - 99205, for all carriers in the nation. CERT projected the national dollars paid incorrectly amount to be $182,344,630.00.
The latest data available for South Carolina comes from the November 2005 report with an error rate of 9.2%
For the state of South Carolina, the specialty of orthopedic surgery had the most errors. From the November 2005 data, most codes were reduced by at least one level. Notably the most often missing or insufficiently documented component involves the examination of the patient.
According to CPT © 2007, a new patient 'is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years.' A professional service is defined as 'a face to face service rendered by a physician reported by a specific CPT code.'
All documentation to support services billed should be sent to AdvanceMed or the CERT documentation contractor immediately upon request to avoid an overpayment. We suggest that you designate one person in your office to handle all requests from AdvanceMed.
© CPT ' 2006 Appendix C contains clinical examples of all levels of Exam and Management codes. Additional information on correctly coding evaluation and management services can also be found on our Web site at www.PalmettoGBA.com. Select Learning and Education from the drop down box. Then, choose workshop handouts on the left hand side of the page. And finally, choose 2005 Medicare Part B Evaluation and Management Workshop Handout. You can also find an on line workshop regarding subsequent hospital visits on our web site at the home page under on-line learning.