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WC Billing Question

  1. #1
    Default WC Billing Question
    Medical Coding Books
    When a patient is an established patient with the practice, and they are coming in with a new injury/illness, that is work related, can you bill that visit as a new patient?
    My first thought when following CPT Guidelines, is no....I am seeking additional thoughts on this! Trying to help out a fellow biller!
    Thank you!

  2. #2
    North Carolina
    This will really depend on your WC carriers. Our industrial comm. defines a new patient as one who has a new injury.

    New Patient

    A new patient is one who is new to the physician or an established patient with a new industrial injury or condition. Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.

    Established Patient

    An established patient is a patient who has been seen previously for the same industrial injury or illness by the physician.

    With that being said, we have some W/C carriers that honor this guideline and some who follow CPT's definition.

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