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New vs. Established Patient

  1. #1
    Location
    Overland Park, KS
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    1,166
    Default New vs. Established Patient
    Medical Coding Books
    I have an issue with determing if in this scenario the patient would be new or established.....I am aware of CPT and the three year rule for new vs. established patients and that CPT says it is a face to face or a professional service.

    Here is my question...a patient who has never been to the clinic before presents for a urine drug screen (pre-employment) and sees the MA for this. The patient returns a few weeks later for a problem-oriented visit and sees the provider (MD). Am I correct that this patient would be a new patient because they were only seen the first time by the MA and no provider?

    What would happen if the the patient saw the provider for the urine drug screen? Would this then establish his/her care since no E/M service was techincally provided? Pre-employment drug screens are pretty straightforward. There really is little to no history (certainly no HPI) and no exam is performed either. New or established in this case?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Columbia, MO
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    12,527
    Default
    I did not think an MA could see a new patient for anything since all of their visits need to be incident to. So if you submit the claim using the physician NPI then you established care for a patient he never attended to. So I think you cannot do the first visit with just the MA and yes it is established. JMO

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Overland Park, KS
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    1,166
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    We will not be submitting a claim for this. It gets billed to the employer, not the insurance.

    Am I correct then that in the first scenario, the patient is new, and if the provider did the service, they would be established?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Dawson,

    We provide occupational and workers comp services to employers, also. We, too, bill the UDS to the employer (pre-employment). If the patient is only coming in for a pre-employment drug screen and doesn't have an encounter with the physician, the next face-to-face encounter with the provider would be new....IMO.

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Got it! Thanks. Now, if the provider does the pre-employment drug screen, then this will establish care? Correct?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. #6
    Location
    North Carolina
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    3,126
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    Out of curiosity...why is the physician collecting/performing the uds?

  7. #7
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    That is a good question that I don't have an answer for at the moment. This is quite unusual.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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