New pt or Consult visit?

[Jess1980]

Can anyone provide assistance on this? have a GI practice that sees patients from another GI. The other GI in town left. The dr that left was in a separate practice. We are seeing lots of their patients for the first time but not as a second opinion or a transfer from their care. We are seeing them with a referral request from their PMD. However, they have seen doc in our specialty in the last year in most cases.

For these new patients, the other GI doc left town and did not transfer the patients. After he left, they had no GI doc and the pediatricians sent new referral requests to evaluate and manage their chronic GI complaints. No second opinion was requested and in almost all cases no continuation of care was requested. For many of them, we didn't know they saw the previous GI doc from the paperwork until we interviewed the patients during the visit. We always send letters back to the referring doc with the items you listed included.

Would you code these as a new pt or consult? I am leaning towards new pt.

 

[rlmiller]

I would follow the CPT New and Established Patient guidelines. So if another physician within your group practice has given any services to the patient within the three year time frame your charge would be an established patient visit (99212-99215). For those patients that have not seen a physician within your group practice then I agree with you and would be a new patient, if you are taking over care for the GI related issues. If you are just consulting based on the referral from the primary care physician and returning care to them then a Consultation code would be appropriate.