New Patient

[ClaraMurphy]

Here is a coding question?

New Patient is defined as 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.

This is a Family Practice Group of physicians. They cover weekends and on call time with another non-associated Family Practice Group. So if our family practice physician is on call this weekend and he see’s and treats a patient on behalf of the other group practice could we code it as new patient?

My coding call is we can charge as new patient- if our group of physicians has never seen or treated this patient in past three years they are new to us- correct?

[rthames052006]

Originally Posted by ClaraMurphy

Here is a coding question?

New Patient is defined as 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.

This is a Family Practice Group of physicians. They cover weekends and on call time with another non-associated Family Practice Group. So if our family practice physician is on call this weekend and he see’s and treats a patient on behalf of the other group practice could we code it as new patient?

My coding call is we can charge as new patient- if our group of physicians has never seen or treated this patient in past three years they are new to us- correct?

I do believe if you are covering for another physician that pt is established to you as well. I don't have any of my reference materials with me now but I do believe I am correct.

[deedeefronius]

If all the doctors involved are working in the same practice and the patient has seen any 1 of those doctors in the past 3 years, then it IS NOT a new patient visit. It does not matter if the doctor in question has never seen the patient and is covering for the PCP.

If the patient has not been seen by any doctor in the practice in over 3 years, it does not matter who sees them, it's a new patient visit.

I hope this clarifies things for you.

[katmryn78]

If you look in CPT on the first page regarding E/M service guidelines it states that "In the instance where a physician is on call for or covering for another physician, the patient's encounter will be classified as it would have been by the physician who is not available."

Laura, CPC, CEMC