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consult or new patient visits. every 3 years or 2 years

Kandyce Posted Tue 28th of May, 2013 22:28:38 PM

I would like clarification on when to bill new patient codes for Mcare (consult) for cardiology physicians when a patient is coming back to see them after some time has passed. I am under the impression it is 3 years. Is that correct?

SuperCoder Answered Wed 29th of May, 2013 13:43:41 PM

True.

PATIENT TYPE

For purposes of billing for E/M services, patients are identified as either new or established, depending on previous encounters with the provider. A new patient is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years.

An established patient is an individual who has received professional services from
the physician/NPP or another physician of the same specialty who belongs to the same
group practice within the previous three years.

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