Cardiology Coding Alert

Question: One of our cardiologist's saw a patient for the first time this week, but the record shows the doctor read an ECG for the patient 16 months ago. Should I use a new or established patient office visit code?

Arizona Subscriber

Answer: You should use a new patient E/M code for this encounter, based on the information you provide. So you should choose from 99201-99205 (Office visit for the evaluation and management of a new patient...).

Support: "An interpretation of a diagnostic test, reading an x-ray or EKG, etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient," states Medicare Claims Processing Manual, Chapter 12, Section 30.6.7 (www.cms.hhs.gov/Manuals/).

Applying that rule to your case, you see that although the cardiologist previously interpreted the patient's ECG, he did not have a face-to-face encounter with the patient until this week. So for this face-to-face encounter, the patient still can be a "new" patient under E/M coding guidelines.

Watch for: You also need to check whether the patient has seen any other physician in the group in the past three years. A new patient is one who has not received a professional (face-to-face) service from the physician performing the encounter or another physician of the same specialty in the same group during the past three years.