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Wiki New vs Established

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Melissa Harris CPC

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We have patient's referred to us (physicians office) for pain management procedures (epidural injections, etc). They only have the procedure with no evaluation by the physician. We do not see or evaluate these patient's prior to the actual procedure. Sometimes these patients are referred back for physician evaluation and management after the initial procedure. Would this be a new patient or established patient???

Melissa Harris, CPC
 
Melissa Harris said:
We have patient's referred to us (physicians office) for pain management procedures (epidural injections, etc). They only have the procedure with no evaluation by the physician. We do not see or evaluate these patient's prior to the actual procedure. Sometimes these patients are referred back for physician evaluation and management after the initial procedure. Would this be a new patient or established patient???

Melissa Harris, CPC
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It would be considered established (if the treatment was within the last 3 years), since there was a face to face service.
 
That is what I initially thought but the questions in the office is the patient who is referred to the office just for an injection considered face to face? No evaluation is done, just an injection or procedure.

Melissa Harris, CPC
 
The injection would have to be performed by the physician so there is a face to face service. An ancillary employee would not be allowed to perform any service with the physician they are employed under first evaluating the patient and documenting a plan of care to be followed. You staff cannot carry out orders from pther providers.
 
Debra is correct. Check the definition of New Patient in the CPT book; it does not specify that there needs to specifically be an evaluation, just that there is face to face Professional Services...which would include any injections that a provider might perform. I know this is frustrating; we go through this in my clinic with our Pain docs, but unfortunately, once they do that ESI, they've lost the chance to bill a New Patient visit if the patient is referred in the future.
 
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