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New Patient - We have had some discussion lately

  1. Question New Patient - We have had some discussion lately
    Medical Coding Books
    We have had some discussion lately on the definition of a new patient. The discussion comes in our surgery dept. Our surgery department is subdivided into 3 different offices. We have general surgeons who might send a patient to see a the surgical oncologist. There isn't a different taxonomy code to identify the oncologist as a different specialty. Is this a new patient?

    Further, in the general surgery office, there is also a thoracic surgeon who has a different taxonomy code. So if my understanding is correct, even though they're in the same office, they're in different specialties so the thoracic surgeon would bill a new patient visit. Am I off track?

    They all bill under the same tax id.

    Thanks for your thoughts.

  2. #2
    Default
    I wouldn't look at the taxonomy codes to identify different specialties. I would look closer at why/what the pt is being referred for.
    This issue is most likely better addressed by the Oncologist - due to a specific component of the patient's condition. This is a different specialty regardless of taxonomy code or tax ID number. This also includes the (cardio)thoracic surgeon.
    Keep in mind of course, the issue/condition should be related to the surgeon's/physician's field of expertise.
    Jason Steeprow, CPC

  3. #3
    Default
    No..... It should be billed as a consultation until the oncologist decides to take over the management of care.

    CPT describes a New Patient as one that has NOT been seen the PRACTICE or another physician of the same speciality who belongs to the same group practice in the last 3 Years. TIN and Taxonomy id's have nothing to do with billing new patient. It is all about the documentation.

    You can however, bill a consultation code, if the provider does refer the patient to the oncologist, which are not based on new or eastablished patient.

  4. #4
    Default
    Good point Blackiez1 - the consult codes are unbiased towards new or established patients.
    Jason Steeprow, CPC

  5. #5
    Unhappy New Patient or Not?????
    I have a question I hope someone can help me with.
    We have a patient here in the doctor's office. They came in a few weeks ago and got a flu shot on flu shot clinic day. (did not see a doctor, nor was the 99211 code used).
    They are here today to see the doctor. Are they still a NEW Patient? I think they are, but I want to make sure before it gets sent out. Being this is the first E/M code being used. Thanks in advance!

  6. Default
    They may be new to the doctor but they are not new to the facility. So I don't think that you can use a new patient E/M code because the patient has been to the facility. I go through this on a daily basis, we have new patients to the hospital's outpatient wound care facility and have never been seen by our doctors, but they have been to other departments in the hospital or have been patients in the hospital, therefore I can't code or bill them as new patients. I have to code and bill them as established patients because they were seen in either the hospital or another department in the hospital within the past three years. I hope this helps and also if this new/established patient rule does not apply to this situation, someone please let the both of us know.

  7. Default
    Another thing that you can do is bill the visit as a consult, since this will be the patient's first time seeing the physician.

  8. #8
    Location
    north seattle wa
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    Quote Originally Posted by jaybehr38 View Post
    I have a question I hope someone can help me with.
    We have a patient here in the doctor's office. They came in a few weeks ago and got a flu shot on flu shot clinic day. (did not see a doctor, nor was the 99211 code used).
    They are here today to see the doctor. Are they still a NEW Patient? I think they are, but I want to make sure before it gets sent out. Being this is the first E/M code being used. Thanks in advance!
    Since you are doing outpatient bililng, this would be a new pt. IF patient has not recieved services from a physician in your office they would be considered new even if they have previously recieved a flu shot because they haven't seen a physician yet.

  9. #9
    Default
    If no E/M service is performed, the patient may continue to be treated as a new patient. For example, if a professional component of a previous procedure is billed in a three-year time period, e.g., a lab interpretation is billed and no E/M service is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of an E/M service does not affect the designation of a new patient.

    This is from TrailBlazer (Texas Medicare).

    This is NOT a consult unless you have a provider requesting the opinion of your physician.
    Last edited by jamcculley; 01-04-2008 at 11:05 PM. Reason: adding a comment

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