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NEW VS. ESTABLISH PATIENTS

Sandra Posted Thu 12th of March, 2015 14:52:26 PM

If we see a patient in the hospital as an emergency and within the 3yrs the patient comes back through the E.R. do we bill the 2nd hospital visit as establish or a new consult? And does the diagnosis come into play (same vs. different) as to how we bill?
We are the on-call Neurosurgeon for the hospital.

SuperCoder Answered Thu 12th of March, 2015 18:54:28 PM

Thanks for your question. The patient would be considered established for the second visit no matter what the diagnosis is. A new patient is someone who has not had any professional services by a physician, NPP or another physician of the same specialty within the same group within three years. The new diagnosis will be significant in selecting the level when choosing your E&M code. See the attached link for additional information.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf

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