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E/M question for new vs established

  1. #1
    Default E/M question for new vs established
    Medical Coding Books
    We have an interventional cardiologist and I am trying to determine whether they can charge a new patient visit after the patient has a stress echo done before seeing the physician. The patient is being referred to her, she has them do a stress test, she is present during the stress and reads the stress, she has them come to the office for the follow-up. Can she then charge a new patient visit? My gut tells me no, but I am unsure, but was told by the office staff that she has always done this. Any place you can refer me to would be helpful.

  2. #2
    Post Link to NP information
    Defining "professional services"

    Varying interpretations of what constitutes a "professional service" have been a source of confusion for practices trying to determine which patients qualify as new. CPT 2001 clarified the matter by defining professional services as "those face-to-face services rendered by a physician and reported by a specific CPT code(s)." The key phrases are "face-to-face" and "reported by a specific CPT code(s)."

    Suppose you provided the interpretation of an ECG for an inpatient you did not actually meet in person. When you see the patient in your office (assuming this occurs within the next three years), you would report the E/M service you provide using a new patient code since there was no face-to-face encounter during the inpatient stay.

    Consider the patient who is new to the community and needs a refill of her oral contraceptives. You agree to call in a prescription that will meet her needs until she can be seen in your office the following week. When you see her for her well-woman visit, you report a new patient preventive medicine service code since you did not have a face-to-face encounter with the patient when calling in her prescription.

    If you are in solo practice, all you need to remember to differentiate new patients from established ones is whether you provided a face-to-face service within the last three years. The situation is different, however, for group practices.
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

  3. #3
    Smile new vs established
    Thank you so much for this. That helps me tremendously.

  4. #4
    Milwaukee WI
    Default Established or consult
    You say "she is present during the stress and reads the stress," which indicates to me that she is providing a face-to-face service. If I interpret this accurately, the office visit "to follow-up" is an established patient visit.

    However ...

    If another physician has asked your interventional cardiologist for a consultation on this patient, the office visit might be a consult.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Default established vs consult
    Will keep this in mind also. As a specialist, she probably will have a lot of consults. Thanks!

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