Cardiology Coding Alert

Question: Sometimes the cardiologist sees a new Medicare patient for the first time in the hospital (as an inpatient), and the patient later follows up in our office. Should we report a new-patient office visit E/M code?

Maine Subscriber

Answer: When this patient comes into your office, she is established. Your physician saw the patient and provided face-to-face medical care within the past three years. The change from inpatient to office does not affect this designation.

What to do: Choose an appropriate established outpatient E/M, such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...), depending on the services the cardiologist documents and performs.

New vs. established: CPT states that if your physician (or any physician of the same subspecialty in your group) has provided any professional services for the patient in the past three years, the patient is established. In the E/M context, CPT defines professional services as "face-to-face services rendered by a physician and reported by a specific CPT code(s)."