AAPC - Back to school
Results 1 to 2 of 2

Thread: New or Est Visit??

  1. #1

    Default New or Est Visit??

    AAPC: Back to School
    If one of our doctors see a client in an outpatient setting, then refers them to our residential treatment center, can they charge for a new patient visit (99204 or 99205) since they try to do a complete PE during their first visit? There is no change in doctors treating the patient but it would be billed under a seperate NPI.

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    As I understand your question, they see the patient in an OP setting; then refer to residential treatment and want to charge a NP visit in the residential treatment center? If that is the question - no, you cannot charge a NP at the residential center; the CPT defines an established patient as one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.

    However, if you are asking about that initial visit in the OP setting, and the patient hasn't been seen by that physician or any other in the same group, same specialty, that would be a new patient visit.

    NP vs. established is not determined by place of service.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

Similar Threads

  1. Preventive visit New or Est
    By shruthi in forum E/M
    Replies: 3
    Last Post: 09-06-2013, 05:48 AM
  2. Preventive visit New or Est
    By shruthi in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 10-13-2012, 11:31 AM
  3. Replies: 2
    Last Post: 12-28-2010, 10:00 AM
  4. Est pt visit: pt on chemo - mdm?
    By andersee in forum Hematology/Oncology
    Replies: 2
    Last Post: 06-24-2010, 12:03 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.