Wiki E/M coding

[stephrose516@yahoo.com]

A patient is an established patient at a clinic/hospital group, but then sees an audiologist or Ophthalmologist on a different day. The patient is new to them. So the audiologist or ophthalmologist charges a new patient E/M code. Wouldn't the patient still be an established patient and should be charge an Established E/M code because they saw those doctors in the same clinic/hospital group? Or would be it still be a new patient E/M code because is speciality. This example is between different patients. I've been seeing this a lot between the Audiologist and Opthalmologist.

Thank you!

 

[AmandaBriggs]

It all depends on how the providers are enrolled with payers. If the providers are enrolled as different specialties/sub-specialties then the patient will be new to each specialist/sub-specialist. I recommend reading the New and Established Patient section of the E/M Services Guidelines in CPT. For example, a cardiologist refers a patient to an electrophysiologist within the same practice. The electrophysiologist would bill a new patient code as they are a different sub-specialty than the cardiologist.

Hope this helps.