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New Patient vs. Established

  1. Default New Patient vs. Established
    Medical Coding Books
    I work for a group of ENTs and we do have an audiologist. If a patient sees the audiologist and then a month later sees one of our ENTs for a different reason (477.9). Do we charge as established or new? Does the audiologist count as a different specialty?

    Thanks for your help!

  2. #2
    Per CPT, a new patient is one who has not received any professional face to face services from rendered by a physician and reported by specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years.

    This is where is gets slippery, did the audiologist bill the services incident to a physician in the group. If they did, from a payer's point of view, the patient did receive a professional service from a physician in the group, and therefore would be considered established.

    If the audiologist billed under their own NPI, then I think you could consider the patient a new patient, since the audiologist is not another PHYSICIAN in the group in that specialty.

    What do others think?
    Last edited by b.cobuzzi; 07-15-2009 at 03:05 PM.

  3. #3
    Stuart Sailfish Chapter
    Barb, that does get a tad tricky, if we bill any claim under the Audiologist, the Physician has to see the patient first (just our protocol) so i would assume that if the MD never charged an E/M then why wouldnt it be considered a new patient
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA

    "Nothing is stronger than the heart of a volunteer"

  4. #4
    Sometimes, with some practices, the audiologists will take audio orders from other physicians from outside practices, so the patient may see the audiologist without seeing the Otolaryngologist in the practice. I am not sure what the original poster's situation was referring to, but she said the audiologist had seen the patient, but the physician had not. I was going off those assumptions.


  5. #5
    Greensboro, NC
    I am helping an audiology practice (no physicians) and my question is can the audiologist charge an E&M code when the patient has been referred to them by a physician. Of course they would have to have met the criteria and documentation for the level of service. Then they might do a hearing test and charge for that.
    Any advice would be appreciated.

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