Billing E/M codes - new vs established

msksmith

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Hello coders!

If a patient has been seen in the same clinic for GYN with a different doctor and returns for a different program service area (STD) and different doctor.... how would this be coded? New or Established? My thoughts it would be coded as an established visit regardless of what service area and doctor instead of the 99203 that was originally coded.

All feedback welcomed! Thank you in advanced! :)
 
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csperoni

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CMS definition from https://www.cms.gov/outreach-and-ed.../downloads/eval-mgmt-serv-guide-icn006764.pdf:
New Patient: An individual who did not receive any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.
I believe the definition is in the CPT book as well.
Unless the different program services are different groups/providers (possible, but very unlikely) this is established. It would need to be a separate TID and providers do not overlap to be considered new within 3 years.
 

msksmith

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CMS definition from https://www.cms.gov/outreach-and-ed.../downloads/eval-mgmt-serv-guide-icn006764.pdf:
New Patient: An individual who did not receive any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.
I believe the definition is in the CPT book as well.
Unless the different program services are different groups/providers (possible, but very unlikely) this is established. It would need to be a separate TID and providers do not overlap to be considered new within 3 years.
Ok and what is TID?
 

msksmith

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Ok and what is TID?
CMS definition from https://www.cms.gov/outreach-and-ed.../downloads/eval-mgmt-serv-guide-icn006764.pdf:
New Patient: An individual who did not receive any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous 3 years.
I believe the definition is in the CPT book as well.
Unless the different program services are different groups/providers (possible, but very unlikely) this is established. It would need to be a separate TID and providers do not overlap to be considered new within 3 years.
Thank you for the info. This is great and I can share this with the provider for a reference!
 
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