Wiki E/M visit new or established

[2believe]

If a patient was seen in our office in 2021 for an EMG TEST cpt 95910 and 95886, no e/m was done. Then in 2022 was seen as a new patient and billed 99205.
Because they didn't have an E/M done in 2021 can we bill a new patient code? I thought it was every three years or is it every three years if no other services were done?

 

[cwickey]

An EMG is a face-to-face testing so it counts as a visit - you'd have to charge an established patient.

 

[amyjph]

If the patient has received "professional services" provided by the physician/QHP or any other physician/QHP in the same practice and exact same specialty and subspecialty in the past three years they are established.
So if Dr. Physiatrist performed an EMG for the patient in 2021 and the same Dr. Physiatrist sees the patient for an office visit in 2022, the patient is established.
There's a decision tree in the front of the E&M section of the CPT book to help you understand.

 

[2believe]

thank you