Wiki 3 year rule on established pt's ?

[cynthiaarellano14@yahoo.com]

does anyone know if the 3 year rule apply's to established inpatients, not sure if I should be billing an established (mcare) pt a consult code when our provider has been consulted, or should I bill a f/u code, thanks or any help on this i can get. CA

 

[em2177]

"New Patient" a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

 

[mhstrauss]

Also, Medicare doesn't accept consult codes. So if the provider has performed any face-to-face services for this patient within the last 3 years, you will have to bill an established visit code.