• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

New patient E&M when insurance carrier changes

NEOSM507

Networker
Messages
41
Best answers
0
A provider sees a patient under private insurance as a new patient (eg 99203), and a year later, the patient presents with a new injury under WC or NF. Can that same provider bill a new patient E&M to the WC/NF carrier?

Thank you
 

cgaston

Expert
Messages
413
Best answers
0
No. A new patient is one that hasn't received services within 3 years. Their insurance changing does not change the fact that they have seen the provider within the past 3 years.
 

CodingKing

True Blue
Messages
3,793
Best answers
0
Workers comp my follow different rules so its best to contact them to be sure. I think some WC carriers go based off new injury and not the CPT definition of a new patient. Though if it were the other way around if they were seen for WC then go to normal insurance its established for the normal insurance.
 

NEOSM507

Networker
Messages
41
Best answers
0
We contacted the board and they only advised us to follow CPT. Yet I still have physicians who argue this.
 
Top