tci General Surgery Coding Alert - 2010 Issue 6

Reader Questions: Clarify 'New' Versus 'Established' Patient

Question: Our practice performed a test on a patient who was referred to us by another doctor. Our surgeon was not present for procedure; a technician administered the test. Should I consider this patient an established patient? Mississippi SubscriberAnswer: No, you should consider the patient "new" until a face-to-face encounter with your surgeon occurs. If the primary physician (or another physician billing under the same group number) provided a non-face-to-face service for a patient and then provided a face-to-face service within three years, you should still consider the patient to be "new" when selecting an E/M service code for...

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