Cardiology Coding Alert

Reader Questions :

Follow Face-to-Face Rule for New vs. Established

Question: We hired a new cardiologist for our practice to replace another physician who left. The new physician thinks he should be able to bill 99205 because patients who have been coming to us for years are new to him. Should we be billing new or established E/Ms?

Iowa Subscriber

Answer: Generally speaking, what you describe is not a new-patient scenario, and 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) is not appropriate.

"New patient" means a patient who has not received any professional services, such as an E/M service or other face-to-face service (like a surgical procedure) from the physician or physician group practice -- with the same physician specialty -- within the past three years.

(Remember to check whether your payer considers EPs to be the same specialty as cardiologists.)

So, for instance, reading an ECG in the absence of an E/M service or other face-toface service with the patient does not affect the new-patient designation.

If you are using the same tax ID number, the established patients are still established, and you should use 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

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