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Thread: E/R - Established or New

  1. #1
    Join Date
    Apr 2007
    Charm City - Baltimore

    Default E/R - Established or New

    AAPC: Back to School
    We are having a discussion on whether or not we should consider (for E/M Auditing worksheet purpose) on this scenario:

    Patient who is seen in our ortho practice previously and is considered Established, presents to the E/R with a traumatic hip injury. Patient is admitted and the ortho on-call is called for consultation. This is the same doctor who previously did the patient's hip surgery. He performs a consultation.

    Using the Medicare E/M auditing sheeting, there is Box A which asks is this an Established Patient with or without addt'l workup planned. Or is this considered a New Patient with or without addt'l workup planned?

    Any feedback would be appreciated - we are tied here.

    Crystal, CPC, CCS-P

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Doesn't matter for consult

    If you are billing a consultation, it makes no difference whether the patient is new or established.

    But to answer your question ... If the patient was seen within the last 3 years this is an established patient.

    Finally .. I think your audit tool is a bit confused. The "with additional work-up" and "without additional work-up" apply to NEW PROBLEM (whether it's a new patient or an established patient). I would say you have a new problem because this is a traumatic injury. Even if this is the same ortho surgeon who repaired the hip previously, a traumatic injury is by definition a new problem.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Charm City - Baltimore


    Thanks for the tie-breaker!
    Crystal, CPC, CCS-P

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