Wiki New patient visit after PFTs

[tippetoes@yahoo.com]

If a patient is referred to pulmonary office for PFTs only and then referred back for consultation for asthma, would the patient visit be coded as a new patient or established patient? The provider never saw the patient for the PFTs.

 

[SharonCollachi]

Who did the PFT and who billed it?

 

[Christal]

We had a situation similar to this where we had a patient in the office for new patient visit and did PFT. The patient had to leave for an emergency prior to seeing the provider. We billed the PFT that was performed and got payment. Then when patient came back another day to see the provider for a consult as a new patient the visit was denied because we had billed the PFT with same provider. I would say it would be an establish patient if you billed for the PFT.

 

[csperoni]

I would consider a PFT a "professional service or other face to face service" and therefore this is established.
Here's a good Noridian article about new vs established. https://med.noridianmedicare.com/web/jeb/specialties/em/new-vs-established-patient

New Patient
Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.​