Internal Medicine Coding Alert

Published on Mon May 01, 2000 PDF

Question: A new physician recently joined our practice. He is seeing a patient that he has never seen, but who has been seen by other physicians in the practice. Can the new physician bill a new patient evaluation and management (E/M) code?

New Jersey Subscriber

Answer: The physician can bill a new patient code if the patient has not been seen in the group practice for more than three years. If the patient has been seen by a physician in that group practice within the past three years, an established patient office visit E/M code (99211-99215) must be used, says Cindy McMahan, CPC, an independent coding consultant in Albany, Wisc. If the new doctor is a subspecialist and is consulting to the other physicians (he or she is seeing the patient and offering a medical opinion back to another requesting physician), the physician can bill his service as a consultation (99241-99245, office or outpatient; 99251-99255, initial inpatient; 99261-99263, follow-up inpatient; 99271-99275, confirmatory consultation) with the other practice member referring.