new patient after Dr. prEMGeforms

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If a referral is made for a EEG to neurology and the Dr. preforms and interprets the test sends it back to the ordering provider. Then the PCP decides to refer the patient to neurology the patient is scheduled with the same provider that preformed the test are they still considered a New patient?
 

thomas7331

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A patient only becomes established after a face to face encounter. Interpretation and report of a diagnostic test is usually not considered face to face, so if your physician or practice has not actually seen the patient before, they would be considered new.
 

CodingKing

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"Dr. preforms and interprets the test" I'd call performing the face to face part so established. If it was just the I&R portion then new patient.
 
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The patient is only having the test performed by the Dr. A chart was not started for being seen and the info was sent to the PCP for them to go over with the patient. no history and physical was done no review of medications only vitals and test the reason the Dr. was in the room was for the EMG guidance this can not be preformed by a tech. Do you still feel this is an established patient (They would still need a referral to be seen by the Dr. after the test was preformed)
 

thomas7331

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Based on what you're saying, I would bill the patient as new. If for the EMG you are just billing codes with a TC/PC split, e.g. codes from the range 95860-95887 for EMGs, most payers will not consider the patient established. Generally speaking, surgical procedures and E&M visits are usually what will establish the patient in payer systems. But payers are unpredictable - sometimes you have to use your best judgment and hope for the best or appeal/correct the claim if it denies.
 
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