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New patient E&M when insurance carrier changes

  1. #1
    Default New patient E&M when insurance carrier changes
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    A provider sees a patient under private insurance as a new patient (eg 99203), and a year later, the patient presents with a new injury under WC or NF. Can that same provider bill a new patient E&M to the WC/NF carrier?

    Thank you

  2. #2
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    No. A new patient is one that hasn't received services within 3 years. Their insurance changing does not change the fact that they have seen the provider within the past 3 years.
    Carol Gaston CPC CRC CPCO

  3. #3
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    Workers comp my follow different rules so its best to contact them to be sure. I think some WC carriers go based off new injury and not the CPT definition of a new patient. Though if it were the other way around if they were seen for WC then go to normal insurance its established for the normal insurance.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  4. #4
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    We contacted the board and they only advised us to follow CPT. Yet I still have physicians who argue this.

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