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[vdyer]

I am kind of confused about something, maybe someone has an answer. If a patient has seen a GI doctor ONLY for a procedure, as outpatient, (has never previously been seen by the GI), and then follows up with that doctor for an office visit, would the office visit be coded new or established?

Thanks for the help!

 

[OCD_coder]

Established.

'New patient' means a patient who has not received any professional services, such as an E/M service or other face-to-face service (e.g., surgical procedure), from the physician or physician group practice (same physician specialty) within the previous three years.

For example, if a professional component of a previous procedure is billed in a three year time period (e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed), then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of an E/M service or other face-to-face service with the patient, does not affect the designation of a new patient.

Reference:
The CMS Medicare Claims Processing Manual, (PDF, 1 MB) Chapter 12, Section 30.6.7

 

[vdyer]

Thanks very much, Michelle!