Wiki New patient/Flu Injection

[rdavies]

Our physicians offer a walk-in flu clinic that is open to the public. A flu injection is given to a person that is not a patient of record. A record is created at the time of the injection. A couple of weeks later the patient presents with a sore throat. Should the sore throat visit be coded as an new patient or established patient visit? I understand an E & M is a face to face visit with the physician. The injection was not face to face but the adminstration code was billed to the insurance company with his name on the claim. I am looking for documentation to support the correct answer.

 

[btadlock1]

Our physicians offer a walk-in flu clinic that is open to the public. A flu injection is given to a person that is not a patient of record. A record is created at the time of the injection. A couple of weeks later the patient presents with a sore throat. Should the sore throat visit be coded as an new patient or established patient visit? I understand an E & M is a face to face visit with the physician. The injection was not face to face but the adminstration code was billed to the insurance company with his name on the claim. I am looking for documentation to support the correct answer.

Established. CPT defines a new patient as one who hasn't received any professional services (eg, anything that has a CPT/HCPCS code) from the same provider, or from another provider of the same specialty, in the same group practice, within the past 3 years. Since the flu shot was billed under his name, the E/M will be established. The ONLY exception to this is with Medicare patients; Medicare makes exceptions for non-face-to-face services, with respect to the 3 year rule. The service in question, though, would be considered face-to-face, since the patient had to actually come in to get the shot.

See: http://www.aafp.org/fpm/2003/0900/p33.html;)

 

[rdavies]

Thank you for the information.