Wiki New patient E&M when insurance carrier changes

[NEOSM507]

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]

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]

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]

We contacted the board and they only advised us to follow CPT. Yet I still have physicians who argue this.