• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Pediatric Inpatient/Outpatient

broundy

Guest
Messages
47
Best answers
0
I truly hope someone can solve a problem for me. In the hospital I work at no one seems to be sure how it works from inpatient to outpatient and established patient versus new patient. If a baby is born and is a preemie and seen by the neonatologist and then 4 months later the same neonatologist sees the child in the outpatient clinic once again as the neonatologist for another diagnosis such as slow behavioral growth etc how can this be charged? It is the same physician, same hospital just one of the outpatient clinics in the hospital. He says he can charge a new patient the first time,which makes sense. By the way, obviously the first time was inpatient. Then, he says he can charge a consult on the second visit or new patient on the second visit. The way I understand it if you see the same patient within 3 years it is always established regardless and is it even possible to charge a consult ? Sorry to be so wordy but I need to settle this quickly before it is done incorrectly for any length of time.

Thanks so much

Bonnie
 

bhaskins1

Networker
Messages
92
Best answers
0
Per CPT guidelines...
"A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the last three years."

It seems pretty clear that if he provided professional services within the last 3 years it is no longer a new patient even if he is seeing the patient for a different reason. Inpatient/Outpatient should not make a difference. What you describe is a new problem, not a new patient so you are absolutely right about not coding for a new patient. Having said that... if the patient is referred to him for a consult by another physician he can charge for a consult.

Office or Other Outpatient Consultations do not differentiate between new or established. CPT specifies the guidelines for a consultation... (see the guidelines for consultations in your CPT book just prior to cpt 99241) any follow-up visit however would be coded with the appropriate established patient e/m.
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
Barbara is absolutely correct

Barbara is absolutely correct. Any visit after the first visit is an established patient, as long as it falls within 3 years of the first visit.

EXCEPT, if the baby's pediatrician (or other provider) has requested a consultation from the neonatologist, this might be coded as a consult (depends on documentation).

F Tessa Bartels, CPC, CPC-E/M
 

broundy

Guest
Messages
47
Best answers
0
Thank you both very much for your quick reply. No one seems very happy with the outcome, especially the doc charging a consult every visit, but it is better to stay compliant! As for the rest, I guess just deal with each problem as it arises.

Once again, thank you very much

Bonnie Roundy, CPC
 
Top