Wiki Physician Billing

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elaineb50

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We have a physician that is new to our practice.

He has a patient that is seeing him for the first time with our practice but he was a patient of the doctor at his old practice.

Can we bill an office consult for the first time the patient sees the doctor at our practice? Since the patient is new to our practice or do we have to bill an office visit because the patient was seeing the doctor at his old practice.
 
Consults

Because the patient followed the doctor, he/she is considered an established patient. Therefore, you cannot bill a consult.
 
Agree...established. Medicare FAQ...

Can the physician bill for a new patient exam if he/she leaves a practice for a new one and the Medicare patient comes to the new office to see that particular physician?

No. The phrase "new patient" means that a patient has not received any professional services (i.e. evaluation and management) or other face-to-face services (i.e. surgical procedure) from the physician or physician group (same physician specialty) within the last three years.

Also...

When you change practices

Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that's passed since your last encounter with the patient is the determining factor.

http://www.aafp.org/fpm/20030900/33unde.html
 
But ...

The posters are all correct that this is an established patient.

BUT ... you might still have a consult. It depends on whether the patient was sent by a qualified provider to your physician for advice/opinion on management of a problem.

For example, patient is going to have knee surgery but is diabetic and the ortho surgeon has asked for a consultation on patient's diabetes management before surgery.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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