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New patient office visit denied after EMG


Best answers
Our neurologists perform EMG testing for other physicians. At that time, the patient is not "worked up" like a new patient. History, ROS, etc. is not taken. Only the EMG test is performed. Occasionally, the patient is then transferred to us for further care if there is an issue that needs to be addressed. We are having issues with insurance companies denying the New Patient Office Visit because they state the patient was already seen by the physician. Has anyone else had this problem? If so, how did you handle getting the claim paid?


True Blue
Hartford, CT
Best answers
The definition of a new patient (per CPT) is one who has not received any professional services by the physician within the past three years. A professional service is defined (again per CPT) as those face to face services rendered by a physician and reported by a specific CPT code. If the neurologist perfomed the testing it would be considered a face to face service (as opposed to reading an x-ray and submitting a report, etc.), therefore when the patient is seen at a later date he/she would be considered established