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New or Est Visit??

  1. Default New or Est Visit??
    Medical Coding Books
    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
    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

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