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consult, new patient or established visit?

  1. Default consult, new patient or established visit?
    Medical Coding Books
    The question is … Our physician saw a patient as a consult at our facility. However, she was seen as an inpatient at the hospital by a physician in the same group same specialty. Our physician belongs to 2 groups. He is able to bill under 2 different tax ids. Should we charge a consult, new patient or established visit? Also, what is the highest level for an office visit a nurse practitioner may charge?

  2. #2
    Central Pittsburgh
    If only the answer were simple. There are a lot of factors to consider.

    1. Was the patient sent in consultation by another provider for this office service?
    2. Was the problem the same as what the other MD had seen the patient in the hospital for?
    3. Which ID# was the first service submitted under?

    This particular visit can be consultation if:
    1. Another provider was asking for the opinion of this MD for a particular problem.
    2. This is documented in the patient's medical record.
    3. A report is sent back to that particular requesting physician.

    If the problem is the same as the inpatient problem, I am inclined to bill this as an established service

  3. Default
    Thank you and have a Happy Thanksgiving!

  4. #4
    Evansville Indiana
    Default NP
    An NP can bill a 99205, or 99215 just like an MD.

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