Wiki WC Billing Question

[kkehoe77]

When a patient is an established patient with the practice, and they are coming in with a new injury/illness, that is work related, can you bill that visit as a new patient?
My first thought when following CPT Guidelines, is no....I am seeking additional thoughts on this! Trying to help out a fellow biller!
Thank you!

 

[RebeccaWoodward*]

This will really depend on your WC carriers. Our industrial comm. defines a new patient as one who has a new injury.

New Patient

A new patient is one who is new to the physician or an established patient with a new industrial injury or condition. Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.

Established Patient

An established patient is a patient who has been seen previously for the same industrial injury or illness by the physician.

With that being said, we have some W/C carriers that honor this guideline and some who follow CPT's definition.