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Consultations

  1. #1
    Default Consultations
    Medical Coding Books
    If a physician bills for a new in-patient consultation while the patient is in the hospital would they also bill for a new patient when the patient is first seen in his office or would it be an established since they were seen in the hospital?

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default 2nd visit is established
    No matter where you first see the patient, when you have the second face-to-face visit the patient is established (as long as there is less than 3 years since the last visit).


    F Tessa Bartels, CPC, CEMC

  3. Default consult
    I would think that it would be a new pt, due to the fact that he is new to the practice. could be wrong but would love to hear also what others think.

  4. #4
    Default
    If he bills for a NEW patient consult in the hospital, he cannot charge a new patient office visit. He will be established at that point. So, I suggest charging an established visit. If the patient has not been seen in 3 years by your physician or by any physicians in the same group practice and same specialty, then you could charge a new patient. But in this case, he is new to the physician in the hospital, and established after. Hope this helps!

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default lfoote is incorrect
    Quote Originally Posted by lfoote_25 View Post
    I would think that it would be a new pt, due to the fact that he is new to the practice. could be wrong but would love to hear also what others think.
    Nope ... the first visit is an inpatient consult. If the patient then comes to your office after discharge from hospital the patient is established, as you have provided a face-to-face service to that patient within the past three years.

    There are MANY questions on this forum on this topic. The answer is always the same.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Definition of New Patient for Selection of E/M Visit Code

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

    Just to sums up with Jennifer and Tessa already said...This would be an established visit...
    Last edited by RebeccaWoodward*; 11-10-2009 at 04:49 PM. Reason: spelling

  7. Default
    Establised

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