Neurology & Pain Management Coding Alert

Question: We had a patient seen for a consultation in a hospital, and our physician billed 99255 (Inpatient consultation for a new or established patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity&). After discharge, the patient was not instructed to follow up at our office.
Eight months later, the patient called in and wants to see our same physician because the patients vertigo is getting worse. Should we consider this patient established to our practice even though he has never been to our office? We have no office medical record on him. Is this is a new or established patient visit? Florida Subscriber Answer: According to CPT, the patient is considered established because eight months ago your physician provided face-to-face professional services for the patient. A new patient is one who has not been seen by your physician [...]