We have a lingering question about when to charge new vs established in a hospital outpatient setting. We understand the 3 year timeframe......but we are kind of stumped on certain scenarios:
1) A patient comes in to the Ortho clinic brand spanking new to the facility. We charge a new patient level. But what if that patient comes back in 2 years to see the ENT specialist? Should we charge a new patient since it's a new specialty or an established patient because they have been seen in the outpatient clinic before???
2) What if a patient comes in to see a podiatrist in 2019 as a new patient and then comes back in 2020 to see a different podiatrist from a different organization altogether? Would that be a new patient because they are seeing a podiatrist from a different organization or an established patient because they are seeing a podiatrist.
3) Patient was seen in the ER and referred to Ortho. Since ER is considered outpatient, would we charge a new patient visit or established since they technically have already been seen in our facility?
We use the PMIC CPT Plus book in our facility, but the language regarding new and established patients in the outpatient setting has been interpreted many ways. Is there any clear-cut language out there we should be looking at to help pin this down?
Thanks for any input!
Carissa S
1) A patient comes in to the Ortho clinic brand spanking new to the facility. We charge a new patient level. But what if that patient comes back in 2 years to see the ENT specialist? Should we charge a new patient since it's a new specialty or an established patient because they have been seen in the outpatient clinic before???
2) What if a patient comes in to see a podiatrist in 2019 as a new patient and then comes back in 2020 to see a different podiatrist from a different organization altogether? Would that be a new patient because they are seeing a podiatrist from a different organization or an established patient because they are seeing a podiatrist.
3) Patient was seen in the ER and referred to Ortho. Since ER is considered outpatient, would we charge a new patient visit or established since they technically have already been seen in our facility?
We use the PMIC CPT Plus book in our facility, but the language regarding new and established patients in the outpatient setting has been interpreted many ways. Is there any clear-cut language out there we should be looking at to help pin this down?
Thanks for any input!
Carissa S