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new vs. est when patient was seen as a Consult in the hopsital

Sharon Posted Wed 03rd of December, 2014 17:47:42 PM

If a patient see Dr. A(the doctor is doing a consult) in the hospital and then the patient see Dr. A in their clinic two days later for a follow-up can the clinic bill the appointment as a new patient or should it be billed as an established patient?

SuperCoder Answered Fri 05th of December, 2014 05:04:03 AM

Merry Christmas,
In the scenario above, the provider would need to bill an Established Patient E/M code for the return visit of the patient (99211-99215). Although it may be the first office visit, the patient has already established care with the physician. This is due to CPT guidelines that although it was not a typical office visit, the provider had a face-to-face encounter with the patient in the hospital.
Thanks

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