Wiki BILLING A NEW PATIENT E&M DAYS AFTER A FULL SERVICE EEG IS DONE IN THE SAME OFFICE

[siefring]

Hello,
I work for a Neurologist office and recently we had a rejection of a new patient E&M service because a full-service EEG was done a few days prior.
Apparently, they felt the technical component satisfied the requirements for a face-to-face service with the physician and precluded him or others from the same department from billing a new patient exam. Since the definition of a technical service is technical component includes Portion of a health care service that identifies the provision of the equipment, supplies, technical personnel, and costs attendant to the performance of the procedure other than the professional services.
Our physicians do not see the patient when an EEG is done, they just read the test. I feel they should be able to bill a new patient visit. Am I wrong?
Thanks for you advice,
Lois

 

[thomas7331]

I agree with you. The definition of a new patient is one who has not had a face-to-face service with the provider. The performance of a diagnostic test that does not involve the presence of the provider, or involves the provider for the interpretation and report only, is not considered a face-to-face service. I'd note though that a few payers may not adhere strictly to this definition and may deny a new patient code if they have a previous professional service in their system, however I would consider those incorrect denials if it was not a face-to-face service and would appeal the denial.