Hospital Outpatient billing; new problem

cvand1972

Guru
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Hello All. I need help.

One of our Cardiologists is asked to 'Consult' on a patient in Observation Status at the hospital for a 'new problem'. The patient is an established patient. The Cardiologist did not admit the patient to Observation, he was just asked to see the patient.

Consults aren't covered.
Can I bill this as a 'new patient' office or other outpatient visit (99201 thru 99205) because this is a 'new problem' or do I have to use the 'established codes' (99211 thru 99215)??
 

KRivers26

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Hello,
Have you tried using the Observation Care E/M codes? I am not too familiar with them,but they are applicable to patients seen in "observation". Observation codes also do not make a distinction between new or established patients. In any case, the patient would be established if he/she has been treated by your provider within the last 3years regardles if the patient has a new problem. The patient is new if he/she has not seen your provider or another provider of the same specialty in the same group within three years. :)
 

cedwards

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Hamden
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My understanding is that you would bill an established patient E/M service.

The Observatoin codes are only to be used by the supervising pysician. See MLN MM6740
 
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