AAPC - Back to school
Results 1 to 3 of 3

Thread: New vs. Established for Radiology Physician

  1. #1

    Question New vs. Established for Radiology Physician

    AAPC: Back to School
    I work for a group of radiologists-- a few times a month one of our radiologists goes to a vascular clinic and sees patients face to face - normally as a consult to see if the are good candidates for procedures such as epidurals of venous ablation.

    Any who I have a denial:

    I billed 99202 (new pt) and I am being denied for "PAYMENT ADJUSTED BECAUSE NEW PATIENT QUALIFICATIONS WERE NOT MET".... now 2 years ago our office read an ultrasound done on this patient but this is the first time we saw the patient face to face or billed an OV in six years.

    Per the CPT book: Distinguishing between new & est. patients, professional services are those face to face services rendered by a physician and reports by a specific CPT code. A new patient is one who as not received any professional services from the physician (or one from same practice) with in the past 3 years.

    So my dilemma..... Is this a New Pt Ov b/c we have not seen the pt face to face in over 3 yrs? ...... or...... Is this an est. pt. bc we have billed a prof. component w/in the past 3 yrs?


  2. #2
    Join Date
    Apr 2007
    Nashville AAPC Chapter


    Technically you have billed for services within the last 3 years, so the insurance company is correct in that patient is established.

    You could appeal it, but good luck.

  3. #3


    So you are in agreement that although we have not had face to face time with the patient, because we have provided professial serivices to the patient, they would be considered established.

Similar Threads

  1. Replies: 9
    Last Post: 09-15-2014, 03:03 PM
  2. Replies: 7
    Last Post: 06-27-2013, 10:19 AM
  3. new vs established patient in new physician group practice
    By KPEAK in forum Medical Coding General Discussion
    Replies: 8
    Last Post: 03-19-2012, 01:40 PM
  4. New vs. Established for Radiology Physician
    By TamaraM in forum Medical Coding General Discussion
    Replies: 6
    Last Post: 09-29-2011, 06:28 AM
  5. Physician & Radiology
    By DoDCoder4You in forum Family Practice
    Replies: 2
    Last Post: 03-03-2010, 05:00 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.