Part B Insider (Multispecialty) Coding Alert

Published on Sun Nov 05, 2006 PDF

Check your billing records for tax IDs, past visits

Myth: If your doctor hasn't seen a patient in your office in the past three years, you can always bill a new patient visit.

Reality: Not necessarily. Even if your doctor saw the patient in another location within the past three years, it may not be a new visit. Further, if another doctor with the same specialty in your group saw the patient within three years, you can't bill for a new patient visit.

Example #1: A group of oncologists has a hospitalist physician who shares a tax ID number with them, says Nancy Giacomozzi, office manager with P.K. Administrative Services in Lakewood, CO. If the hospitalist sees the patient first and then the patient visits the oncologists in their office, then it may not count as a new patient visit, she cautions.

Caution: Check your billing records carefully to make sure no other doctors with the same specialty and tax ID number have seen the patient within three years before billing a new visit, Giacomozzi recommends.  

New resource: Luckily the American Medical Association has included a handy flow chart of new-versus-established along with CPT 2007. It clarifies that only face-to-face services count in determining new or established status, so if your doctor interpreted test results for a patient in the past, you can still claim that patient as a new patient. Also, the location in which a doctor saw the patient doesn't matter.

Example #2: A group practice maintains two offices on separate sides of town. A patient sees general surgeon -A- for a complaint of bowel pain at location -Y.- Six months later, the same patient sees general surgeon -B,- in the same group practice, for a new complaint at location -Z.- This would still count as an established patient visit.

Consults: Also, some specialists seem to believe that whenever they see an established patient with a new problem, they should at least be able to bill a consult. But such a visit only counts as a consult if the problem is really new and if another physician actually requested the specialist's opinion, warns Deborah Churchill with Churchill Consulting in Killingworth, CT.