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"New" vs "Established"

  1. #1
    Default "New" vs "Established"
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    Here is the situation. If one of our Cardiologist does an Echo exam on a patient, and then sees the patients later on, is this patient now New or Established, for the sake of billing an E/M? My understanding is if a face-to-face service is provided, then they are now established.

  2. Default
    This would be a New Patient visit becasue there was no face-to-face service done

  3. #3
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    Quote Originally Posted by dimme85 View Post
    Here is the situation. If one of our Cardiologist does an Echo exam on a patient, and then sees the patients later on, is this patient now New or Established, for the sake of billing an E/M? My understanding is if a face-to-face service is provided, then they are now established.
    If your physician or practice performed or supervised (ie stress echo), then I believe that is considered face-to-face and the patient would therefore be established. There isn't a huge difference in reimbursement between a 99203 vs 99214 (as an example) based on Medicare allowables.
    Lisa Bledsoe, CPC, CPMA

  4. #4
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    The issue that concerns me is Medicare's treatment of it. The bill for the Echo is going to go to Medicare with the Cardiologist as the provider of service. Would Medicare interpret billing a global Echo as a face-to-face encounter? Because there is nothing on the bill that would indicate that a tech performed any of the service.

  5. Default face-to-face
    Quote Originally Posted by dimme85 View Post
    The issue that concerns me is Medicare's treatment of it. The bill for the Echo is going to go to Medicare with the Cardiologist as the provider of service. Would Medicare interpret billing a global Echo as a face-to-face encounter? Because there is nothing on the bill that would indicate that a tech performed any of the service.
    Echo will be performed only the patient by the techinician and that report will be studied by the cardiologist. Once he studies the report then the cardiologist will discusses the codition of the patient which we call as face-to-face encounter. this is what my understanding. any comments on this is welcome.

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