Cardiology Coding Alert

Question: I want to be sure I’m coding correctly for E/M. If our new cardiologist sees a patient who’s established with the practice for a problem another cardiologist in the practice has treated, is the problem new because it’s new to the doctor?

South Carolina Subscriber

Answer: In the situation you describe, you should consider the problem to be established because it is not new to your cardiology practice. 

An FAQ posted by South Carolina Part B MAC Palmetto states, “In most instances, a new problem is one that is new to the provider and being addressed at that visit.” But it then lists two exceptions.

One exception is the situation you’ve described: “The initial visit of an established beneficiary in a single specialty group practice setting with a new provider.”

The second exception is for a “visit by an ‘on call’ or covering provider. In these instances, the established problems are treated as if the beneficiary was seen by the unavailable provider.”