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Gastroenterology Coding Alert

Reader Questions:

Face Time Is Essential to Established Patient

Published on Fri Mar 26, 2010

Question: Our practice performed a test on a patient who was referred to us by another doctor. Our specialist was not present for the test; a lab tech performed the test. Should I consider this patient an established patient? California Subscriber Answer: No, you should consider the patient "new" until a face-to-face encounter with your specialist occurs. If the primary physician (or another physician billing under the same group number) provided a non-face-to face service for a patient and then provided a face-to-face service within three years, you should still consider the patient to be "new" when selecting an E/M service code for the face-to-face service. According to AMA guidelines, there are additional factors to consider as well: The three-year rule is a well-established rule for "new" versus "established" patients. That is, if any physician within a given practice sees a patient within a 36-month period, that patient is considered [...]
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