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Otolaryngology Coding Alert

Reader Questions:

Zoom In on 3-Year Rule for New ENT

Published on Mon Mar 10, 2008

Question: A new ENT is coming over from a nearby county, and her patients will be joining our practice. Should we charge her patients as new, or will they be established because she has seen them before? She was practicing and billing under another tax identification number and will be changing to ours when she starts. North Carolina Subscriber Answer: If your new otolaryngologist has seen the patient within a three-year timeframe, you should count the patient as an established patient (99211-99215), according to AMA guidelines outlined in CPT. If your new surgeon or any other physician of the same specialty in your practice has not provided any professional services to the patient in the past three years, you should consider the patient new (99201-99205)
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