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how to determine new vs est pt in the fac setting

herbolky

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I have recently started coding for our hospital owned cancer center. The cancer center and the hospital have same tax id. The physicians professional fee billing is done by an outsied source under that companies tax ID and the phy NPI. I was told the facility bills are billed under the "hospital NPI"...which I thought was a phy ID...when a pt goes to the cancer center for the first time and has been seen in the hospital face to face by a phy (any phy not necessarily an onc or rad onc) as an IP, OP surg, ER....something other than ancillary no face to face services...how would you determine the new vs est pt status in the cancer center? Also how does the tax ID and the NPI impact the selection of new vs est pt in the cancer center when it is hospital owned.
 

thomas7331

True Blue
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If you are coding for the facility only, you should no longer need to make a distinction between new and established patients. In 2014, Medicare replaced the E&M visits for facility outpatient billing with the generic HCPCS code G0463 which does not distinguish between new and established patients and does not require you to determine a level. If you have commercial payers that still require you to bill your facility charges with the new vs. established E&M codes, then you'd need to check with them to see what their policies are.
 
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