Internal Medicine Coding Alert

Answer: No, it is not appropriate to bill a new patient charge because the patient has a new insurance company, says Tammy Chidester, CPC, billing supervisor, Upshur Medical Management Services Inc., a multispecialty practice in Buckhannon, W.Va.

A new patient, according to CPT, is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years. Even when the physician is on call for or covering for another physician, the patient encounter will be classified as it would have been by the physician who is out.