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Jacqueline Posted Wed 08th of February, 2017 13:10:00 PM
We are nephrologists and recently just hired a surgeon to do access surgery. If he goes to see a patient when that patient is on dialysis at a dialysis facility, can he bill that as a new patient visit since he has never seen the patient before? He is evaluating the patient to see if they need surgery.
SuperCoder Answered Thu 09th of February, 2017 08:00:34 AM


The surgeon will be billing established patient code.

SuperCoder Answered Thu 09th of February, 2017 08:17:20 AM


As per my understanding, the colporraphy is done for the ICD 10 Code range N81.0 - N99.3.

Check with your documentation and select the appropriate code.

SuperCoder Answered Thu 09th of February, 2017 08:20:50 AM

Kindly ignore the second reply.

Jacqueline Posted Thu 02nd of March, 2017 11:04:31 AM
Why would it be an considered an established visit? The Dr has never seen the patient and he is a surgeon.
SuperCoder Answered Fri 03rd of March, 2017 01:27:08 AM


According to CMS, new patient is the one who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. However, in your case the patient has been seen by the group already. Hence the patient cannot be considered as new.

SuperCoder Answered Fri 03rd of March, 2017 01:37:17 AM

Also, in case the patient has not been seen by any of your group member or physician, then only the patient will be considered as new.

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