Question New office visit vs Trauma Surgery

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Hello-

We have a physician that did a trauma surgery but never did a consultation on this patient at the hospital. The surgery was done on the left hand. Patient now coming into our office for the first time to be seen for the right hand. Since we did the surgery on their left hand at the hospital, can we bill a new patient visit for the right hand when this is the patient's visit first time in our office?

Thank you.
 

Pathos

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My local MAC (Noridian) explains this pretty well:

"New Patient
Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.

Established Patient
Individual who has received any professional services, E/M service or other face-to-face service (e.g., surgical procedure) from this provider or another provider (same specialty or subspecialty) in the same group practice within the previous three years."


To answer your question; because the patient saw the surgeon before (during surgery) and had a face-to-face visit (the surgery), then any subsequent encounters/visits within the 3 year threshold with him/her or a similar credentialed provider would make those visits Established. Otherwise, the visits are New Patient. Doesn't matter if the visits were slightly different (surgery vs. office visits), as long as the first one was a face-to-face visit (the surgery).

Hope that helps!
 
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