Wiki OB patient New or Established?


Bloomington, IN
Best answers
For our medicaid pt's we have to charge the first visit with the physician as a level 4 E&M visit. If the patient is new to the practice and has only seen the childbirth educator can I charge the first visit with the physician as a new pt? The ob record has already been established but there has been no face to face contact with the physician. Also if a new pt ob record has been established and the pt has a spontaneous abortion would her first visit with physician be considered a new pt?
Why do you HAVE to charge level 4?

Maybe I'm misinterpreting your statement, but why do you "have to charge the first visit ... as a level 4"? You code based on the documentation and what that supports ... might be a level 2 or a level 5.

In any case ... new vs established ... Is your childbirth educator a provider who is contracted to bill for Medicaid? If NOT, and no prior bill has been generated, then the first visit with the MD could be considered a new patient visit (no professional services within the same pratice, same specialty for 3 years).

BUT ... If the patient has been seen by any provider in the OB service who is contracted with Medicaid within the last 3 years, then the visits are established patients.

Some physician's offices send out fairly comprehensive history forms to be completed and returned before the first appointment ... the "medical record" has been started, but the patient hasn't been seen yet. The first face-to-face visit with a provider is the "new patient" visit.

F Tessa Bartels, CPC, CPC-E/M
Sorry, I should have worded that differently. We do not "have" to charge it as a level 4, that is just the service that the physician normally provides for our new ob patients.
Thank you for your response. I thought I was correct in coding this visit as a new pt but I am getting some conflicting answers. One of my co-workers feels this should be an established visit. She posted a similar question on another coding site and got the answer "established". The nurse our new ob pt's see to begin the prenatal record is not a billable provider. She takes down their history, prescribes prenatal vitamins and orders their labwork and then schedules them to see the physician.