Wiki New vs. Established

[thelton]

We have a debate going on in our department and I would like some opinions from other coders. The debate is:

For new patient office visits, the CPT book defines “professional services” as those face-to-face services rendered by a physician and reported by a specific CPT code”. If a Radiologist performs a face-to-face service, but does not report it, shouldn't that still allow the group to report the patient as a new patient next time a face-to-face service is performed?

I posted this in the Audit forum and one person replied stating it was irrevelant whether the first E/M was billed. I would love some more opinions regarding this subject. Thanks!!

 

[hewitt]

Please provide a "real life" example.

 

[thelton]

This is the situation:

A radiologist meets with the patient to give test results, discuss treatment options, etc. but does not bill an E/M code. When the patient comes back to the office, they want to bill it as a new patient based on the CPT definition of professional service as face-to-face service rendered by a physician AND reported by a specific CPT code. They argue that since the first visit was not billed with a CPT (E/M) code, the next visit would be a new patient service rather than an established.

I would appreciate any and all opinions.

 

[purplescarf23]

Where I work something similar happens. We have a colorectal surgeon and he often times does colonoscopies on patients(w/o seeing them first) then will see them in follow up in the office. We are allowed to bill an est pt code due to he seeing them face to face. It may be your work place policy to bill or not to bill. I just know we are not allowed to bill new if he was seen for colonoscopy prior. Hope the helps a little.

Kelsey, CPC