Oncology & Hematology Coding Alert

Question: I work with a private oncologist who left a group practice in January 2000. We saw a patient for the first time in November 1999 at the old practice and a second time in August 2000 at the new practice. We do not have access to the previous records, and because this is only the second visit, a complete history was taken again. Is the patient new or established?

Wisconsin Subscriber

Answer: Assuming this patient was with another physician in the previous practice, there are two issues here. One, in every state, the patient, by law, has the right to his or her records. There may be concern regarding the patient having the information, but he or she still has that right. In addition, medical records cannot be withheld for non-payment of a bill.

Two, if this patient has not been seen by this physician, even if he was a member of the previous practice, he can bill a new patient visit (99201-99205).

According to CPT 2000, a new patient 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.
Assuming that the patient was seen by another physician in the previous practice, and the physician is now billing under a new tax identification number, which most non-Medicare/Medicaid plans would see as a new practice, then it would be appropriate to bill a new patient visit.

This question was answered by Phyllis Klein, president of P.K. Administrative Services, a Lakewood, Colo.-based medical billing agency, and president of the Association of Oncology and Hematology Administrators.