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New patient billing

Mike Posted Fri 29th of October, 2010 16:48:40 PM

We saw a patient for pain injections earlier in the year and is now coming in for an office visit for eval. Do I bill a new patient code 99205 since patient was never seen for an office visit befor or do I use an established patient code since we have done injections on the patient.

SuperCoder Answered Mon 01st of November, 2010 20:27:51 PM

Use an established patient code. CPT's rule on est versus new patient depends only on whether the physician (or a same specialty partner in the same group)has provided face-to-face services or procedures to the patient in the past three years. Non face-to-face services such as reviewing lab reports and evaluating x-rays do not count toard the rule, but a face-to-face procedure such as a pain injection does.

Jen Godreau, CPC, CPMA, CPEDC
Content Director, SuperCoder.com

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