Wiki Visiting consultant E/M for existing patient

[arrana]

Hi,

We are a community health center that has consulting specialists come see patients periodically. I have a patient who is an existing patient of the clinic but is seeing the consulting pulmonologist for the first time, the place of service is the clinic, not the Dr.'s private practice. The Dr. coded a 99204. Is this correct, or should it be a 99214 as the patient is not new to the clinic where the appointment is taking place? We are doing the billing and EMR management for this visit.

Thanks for your help.

 

[Naveen Rachagolla]

New and Established Patient

Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.


And for Consultants Please visit the below link it might give some idea

And my opinion is he will be a new patient because here the specialty is different and the pulmonologist is seeing the patient for the first time.

http://emuniversity.com/Consultalgo.pdf