Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95

Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Ins Department Supervisor

Heather Posted Thu 13th of August, 2015 10:17:47 AM

I am hoping you can help with this. We have providers that are joining us from a previous practice. Can you let me know if this example that I found of how to bill these visits is correct?

Example #1: Last year, Jane saw Dr. Pruitt, a dermatologist, who practices at ABC Medical Group.
• Dr. Pruitt has since moved his practice to XYZ Medical Group.
• Today Jane sees Dr. Pruitt at XYZ Medical Group. She has never been to XYZ Medical Group.
• Is Jane a new patient?

No. She received a professional service from the same physician within three years, even though the practice group is different.

Example #2: Last year, Jane saw Dr. Pruitt, a dermatologist, who practices at ABC Medical Group.
• Since then, Dr. Pruitt has since moved his practice to XYZ Medical Group.
• Today Jane sees a dermatologist at XYZ Medical Group who is not Dr. Pruitt. She has never been to XYZ Medical group.
• Is Jane a new patient?

Yes. She has not received a professional service from this physician or the practice group within the last three years.

SuperCoder Answered Fri 14th of August, 2015 01:06:54 AM

Example 1 is correct. Report these services as Establish patient. Read the below mentioned example: "Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that’s passed since your last encounter with the patient is the determining factor."

Heather Posted Fri 14th of August, 2015 11:27:10 AM

What about example number two? Is that correct?

SuperCoder Answered Tue 18th of August, 2015 00:22:17 AM

Yes. Your interpretation of Example 2 is also correct.

Related Topics