Wiki New patient visit?

[susan.umble]

I work in Dermatology. We have a patient that has only had laser hair removal, that she paid out of pocket for. Was not billed to insurance. She made an appointment for a skin issue. Can she be billed as a new patient visit?

 

[mhstrauss]

I work in Dermatology. We have a patient that has only had laser hair removal, that she paid out of pocket for. Was not billed to insurance. She made an appointment for a skin issue. Can she be billed as a new patient visit?

If the provider she will see for the skin issue is the same provider, or another provider in the same specialty/subspecialty, that performed the hair removal, then no, it would be a revisit. The payer from the previous visit is irrelevant. If there was a face-to-face service in the last 3 years, then the patient is now established.

 

[teresabug]

I disagree Meagan. She was seen for a "cosmetic" service and paid out of pocket for a service that no insurance would pay for. She is now going to be seen for a medical problem and a new patient E/M is allowed.

 

[mhstrauss]

I disagree Meagan. She was seen for a "cosmetic" service and paid out of pocket for a service that no insurance would pay for. She is now going to be seen for a medical problem and a new patient E/M is allowed.

I respectfully disagree. The CPT definition of "new patient" does not take "medically necessary vs cosmetic" or "private pay vs insurance" into consideration. There was a face-to-face service already provided by that office; if it was by the same provider/specialty, and within the last three years, a new patient code should not be billed.

 

[jdyoutsey]

I agree with Meagan. Payment has absolutely nothing to do with whether a patient is considered new or not. What counts is whether the patient has been seen. Read through the CPT guidelines for E/M services and you will find no mention of payment.

 

[MarcusM]

New patient evaluations are paid at a higher rate than established patients to compensate for the time involved in evaluation of a brand new patient. Once that patient has been seen for whatever reason by the same provider/same specialty as noted above, then that patient is an established patient.