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Neurology & Pain Management Coding Alert

READER QUESTIONS:

Established Patient Still Established With New Doc

Published on Sun Aug 09, 2009

Question: Our practice hired a new neurologist after another neurologist retired. The patients are not new to the practice. How should I code patient follow-ups to the new neurologist? Colorado Subscriber Answer: CPT rules state that patients are considered "established" if they have had a face-to-face professional service with the provider, or a provider of the same specialty, in the same group practice within the past three years. Report follow-up visits with your new neurologist with an established-visit code, (9921x, Office or other outpatient visit for the evaluation and management of an established patient ...) Heads up: A patient could be considered new if never seen by a provider of the same specialty within the past three years, even though they have seen different specialty physicians in a multi-specialty group within the past three years. (See the decision tree in the front of the CPTmanual.) The outpatient consultation codes (99241-99245) are [...]
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