Podiatry Coding & Billing Alert

Question: A podiatrist in our practice read a computed tomography (CT) scan for a patient in the emergency department (ED) but did not see the patient directly during their hospital stay. No one else in our practice was involved in this hospital admission. Now the patient is coming to our office nine months later. For purposes of evaluation and management (E/M) coding, would they be considered a new or established patient?

Idaho Subscriber

Answer: A provider reading the test results itself without making a face-to-face evaluation wouldn’t qualify as an encounter with the patient. To qualify as an existing patient, a provider within your practice and within the same specialty and subspecialty needs to have had an encounter in the last three years, according to the E/M services guidelines in the CPT^® 2023 professional edition.

Although the above event is well within the 36-month limit to consider the patient as established to your practice, since no one in your practice engaged in a direct encounter with this patient, they should still be coded as a new patient.