New vs established E&M

[rrehorn06]

How do I code an E&M Visit with a radiologist for a patient who has previously had diagnostic imaging with the same radiology group, but no previous E&M, within the past three years? Would this be a new or established patient?

 

[OCD_coder]

Answer: New

Medicare IOM; 30.6.7 - Payment for Office or Other Outpatient Evaluation and
Management (E/M) Visits (Codes 99201 - 99215)

A Definition of New Patient for Selection of E/M Visit Code
Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed 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 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.

 

[debflutter]

definitely new.

 

[mssalemny]

New patient- from what you said they had not been seen by the provider or anyone in the practice for 3 years...

 

[Sugumaran]

100% New Patient 99201 to 99205