tci General Surgery Coding Alert - 2005 Issue 9

READER QUESTIONS: '3-Year Rule' Applies to Practice,Not Physician

Question: A patient sees a surgeon in our group practice. Over two years later, the patient returns to the group practice for a new problem but must see a different physician because the original treating surgeon is no longer with the practice. Is this a new or established patient?Michigan Subscriber Answer: Under the guidelines set forth by the "three- year rule," the patient is established, not new.In other words, you cannot bill for a new patient visit just because the patient switches doctors within the group. As long as you are billing under the same provider...

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