Wiki Are babies new or established patients?? Help Please:)

[khristinelouise]

If a provider assists at a delivery in the hospital and then subsequently sees the baby at his clinic (not affiliated with the hospital) for a well visit, would you code the well visit as new or established? Would the answer be different if the provider delivered the baby rather than assisted?

 

[Pam Warren]

Did the doctor bill for any professional services while the baby was in the hospital (i.e. round, circ, etc.)? Remember the delivery is billed to the mom, not the kid. And whether or not the hospital is affiliated with your clinic has nothing to do with it. Did your doc or a doc in his group provide a professional service directly to the kid?

So if he's provided no professional services to the kid previously (nor has anyone in his group), including services somewhere else ouside your clinic, you can bill a new patient well visit. Otherwise, it's established. There's a nice grid and explanation of New vs. Established patients in the front of CPT (pages 4&5). Hope this helps.