Wiki New patient vs established patient

bharathiT

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Patient was seen for pacemaker check(it is face to face procedure visit) at 11.30am and same provider did evaluation & management visit for another problem at 11.45am on same date & both are same specialty (cardiology), can we consider this E/M visit as Est patient visit or new patient visit?
 
I'm sorry, unclear as to whether this was two different providers. You indicate 'same provider" and then "both are same specialty". ????
 
Patient was seen for pacemaker check(it is face to face procedure visit) at 11.30am and same provider did evaluation & management visit for another problem at 11.45am on same date & both are same specialty (cardiology), can we consider this E/M visit as Est patient visit or new patient visit?
If the patient was seen face-to-face again by the same specialty provider from the same group practice (Cardiology docs), and/or by the same doctor within 3 years, then the second visit would be an established visit.

Here is some good reading about New vs. Established by my local MAC:

Noridian - New vs. Established
 
A pacemaker check is a diagnostic test that is not considered a face-to-face service by itself, and does not establish the patient, unless specific payers have different requirements. If the patient had not been seen by this provider, or another provider of the same specialty in that same practice, in the prior three years, then this would be a new patient visit.
 
A pacemaker check is a diagnostic test that is not considered a face-to-face service by itself, and does not establish the patient, unless specific payers have different requirements. If the patient had not been seen by this provider, or another provider of the same specialty in that same practice, in the prior three years, then this would be a new patient visit.

In theory I agree with you, however since the original poster specified the visit being a "face-to-face visit", the visit now qualifies for the New vs. Established rule. The face-to-face visit does not have to contain E/M elements to count towards New vs. Established, as long as the provider actually performs the visit and procedure(s). If a nurse or other medical staff performed the pacemaker check, then I agree with the visit not being a "face-to-face visit".

From Noridian :

For example, if a professional component of a previous procedure is billed in a 3-year time period, (e.g., lab interpretation) 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. An interpretation of a diagnostic test, reading an x-ray or electrocardiogram (EKG) etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

Other examples of non-face-to-face encounter:
  • EKG readings
  • Interpretation of reports and studies
  • Other visits where the provider doesn't see the patient

I'd like to see a reference where a pacemaker visit is not considered a face-to-face visit, despite the provider is seeing and working with the patient.

Thanks!
 
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