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Wiki NEW vs EST patient

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mhissy18

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Hello,

I am new at E&M coding. There is a confusion at our office (esp. requesting authorization) whether to bill E&M as new vs est patient. A patient had an ultrasound at our office and the doctor interpreted the report (with no face-to-face with patient). Then, patient returned for another ultrasound and this time, the doctor had a face-to-face with a patient. Does this mean the patient is established? or does this visit still considered as a new patient visit?

Thank you,

Grace, CPC
 
new vs. established

Hi,

The patient is new in your scenario unless another physician of the same specialty and same group practice has provided a face-to-face service to the patient within the past 3 years. The non-face-to-face service of interpreting an ultrasound or other test does not make the patient an established patient. You can verify this in the E/M guidelines of your CPT manual which includes "face-to-face" as a qualifier for the services within the past 3 years.

Hope that helps.
Cindy
 
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