Wiki New or Established Patient?

[Cher91600]

I just started working with a new office. The practitioner gave someone who was new to the practice a lab order for the Lab Corp phlebotomist to draw labs before the patient's initial visit. Labs are drawn by & billed by LabCorp. Would you still bill a New Patient E&M for the first visit with the provider since no services have been provided or billed directly from our office yet or did the lab order make that patient established. My presumption would be that since this is the first encounter with our provider, and first billable service from our office the NP E&M would apply. Any input would be appreciated.

 

[jmenard]

Per the Medicare Claims Processing Manual, Chapter 12, Section 30.6.7, this would still be considered a new visit. See the guidelines from Medicare below:

A Definition of New Patient for Selection of E/M Visit Code

Interpret the phrase “new patient” to mean a patient who has not received any
professional services, i.e., 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 3 years. For example, if a professional component of a previous
procedure is billed in a 3 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.

 

[Cher91600]

Thank you. That's what I thought, but I wanted to confirm.