Wiki New or existing patient coding question

[pakovacs]

New patient clarification coding

We have a new provider from a completely different office, many of her patients have come to our new office. Does she code the visit as a new office visit or established?

 

[mhstrauss]

New patient clarification coding

We have a new provider from a completely different office, many of her patients have come to our new office. Does she code the visit as a new office visit or established?

If she has already seen these patients within the last 3 years, they will be established once she sees them in the new office. The different POS is irrelevant.

 

[CodingKing]

If they see a different provider first, and they have not been seen by another provider with the same specialty and subspecialty under same TIN, then it can be billed as new.

Established to a practice is more complicated. Same provider is pretty straightforward. If they have seen the exact same provider before; the practice, specialty & subspecialty become irrelevant

 

[ellzeycoding]

Yes, as others have stated... any face-to-face encounter with that provider regardless of Tax ID, location, company, group, etc. within the past 3 years establishes the patient to that provider.

An exception might be if you only provided pathology (e.g., CPT 88305) services to a patient at another location and now provide an E/M and other face-to-face services at a new location. That previous pathology service was not a face-to-face encounter with the patient, so the new face-to-face services would make them a new patient.