In Coding
Feb 12th, 2018
When selecting among E/M codes with “new” and “established” patient categories, most coders know to follow the so-called three year rule. If the provider has seen the patient in the past 36 months, the patient is established. It’s important to stress that the provider must have seen the patient. The Centers for Medicare & Medicaid ...
Sep 29th, 2017
Hospital-based clinics have a relationship with their hospital, although it’s not usually located within the walls of the hospital. The relationship allows the hospital and the clinic to share costs and revenue; whereas, a physician-based clinic is a private physician-owned clinic where all the services and expenses are bundled into a single charge. Clearing Up Confusion In ...
In CMS
Feb 15th, 2016
Most professional coders—even relative beginners—are familiar with the “three-year rule” to determine whether a patient is “new” or “established” with a provider. One common conundrum is how to determine the patient’s status (new or established) if a provider has seen a patient previously, in another location. CPT Assistant (June 1999) explains: Consider Dr A, who ...
In Billing
Aug 4th, 2015
by John Verhovshek, MA, CPC If no member of a group practice has provided a professional (i.e., face-to-face) service to a patient within the past three years, the patient is “new,” according to CPT® and Centers for Medicare and Medicaid (CMS) definitions. For example, Dr. Jones, a new physician in a group of general practitioners, ...
In Billing
May 20th, 2015
by John Verhovshek, MA, CPC Question: If a patient seen at internal medicine then referred to cardio subspecialty within our clinic, is the patient new or established to cardiology? Answer: A patient is new if he or she has not received a face-to-face, professional service from the provider, or a provider of the same specialty/subspecialty ...