Cardiology Coding Alert

Question: One of the cardiologists in my group insists on billing an established patient office visit (99211-99215) for patients he has previously seen on an in-patient basis the first time he sees them in the office. He says that because he has seen them on a professional basis within the past three years, he can no longer consider them new patients. I thought that the three-year guideline only pertains to patients seen in the office or on a hospital outpatient basis by a doctor in the same group and same specialty.

New York Subscriber
 
Answer: Your physician is correct. The Medicare Carriers Manual indicates that when the billing physician or another physician in the same specialty and from the same group practice provides any face-to-face E/M service in the past three years for a patient, the patient is considered an established patient. So, the patient in the situation you describe would be an established patient, and you would report a code in the 99211-99215 range.