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EMG and NEW PATIENT

Renee Posted Wed 11th of July, 2018 08:50:07 AM
My neurologist office is a hospital based facility so all services are billed with POS 22. My neurologist bills the professional component of all the EMG/NCS studies performed at the hospital. So if I bill for example a 95886-26 and 95912-26 within the last three years and now the patient presents to the office today for a physician visit can I bill 99201-99205 or is the patient considered and established patient?
SuperCoder Answered Thu 12th of July, 2018 09:28:50 AM

Hi,

If E&M service has not been performed earlier or within the last three years by the physician, then it is consider to be a new visit. 

As per CMS guidelines, “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 years time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

Please find the below link, Page 13:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R3315CP.pdf

Thanks

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