Wiki new patient E/M

[rleif1sun]

patient was seen by sonographer for routine scan for which MFM signed off and claim got billed under MFM(scan code only). few weeks later during routine prenatal visit an abnormality was noted and was referred to MFM. can the E/M with MFM get billed as new patient although a previous ultrasound has already been billed for this provider?

 

[csperoni]

The first visit with MFM should be billable as new if the only service previously provided was reading a sonogram.
https://www.aapc.com/blog/41276-new-vs-established-patients-whos-new-to-you/

Pub. 100-04, Medicare Claims Processing Manual, chapter 12, section 30.6.7 provides that
“Medicare 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 three years. For example, if a professional component of a previous procedure is billed in a three 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.”