Wiki new vs established after seen for industrial

[Lynn.Graham@pvhmc.org]

Would a patient w/private insurance be considered a 'new" patient, if they had only been seen as a "Work Comp- Industrial" patient during the past 3 years in our practice?
( & visa/versa )
thank you

 

[asuresh.ashokan@gmail.com]

For workers compensation based on the state, my experience we can bill as new patient for Florida state. Also the same will follow some other states

Thanks
Suresh Asokan CPC-A

 

[thomas7331]

The fact that the patient is being covered by a different payer at the visit does not change the criteria for determining whether a patient is new or established. Though some payer rules might vary, in my opinion it would be incorrect coding to assign a new patient code if the physician had seen the patient within 3 years. The extra value assign to the new patient codes is based on the additional administrative and professional work that the provider has to do establish a medical record and become familiar with the patient's history. Assigning a new patient code to an established patient is up-coding, even if it is for a new payer.