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Three year rule when it involves testing

Debbie Posted Tue 18th of October, 2016 10:13:23 AM
We are ENT's and we have a Voice Therapy Lab in our office. I know that if we see a pt within 3 years, the pt would be an EP. However, we saw a pt in Sept 2013, but then he had testing done at our voice lab in November 2013. Both facilities use the same Tax ID#, but technically, the pt did not see our doctor when he had the test, but we do bill Incident Too. He has now came back to see our doctor in Oct 2016. Is he a NP or EP? I am thinking EP, but want to be sure.
SuperCoder Answered Wed 19th of October, 2016 00:58:50 AM

As per the above documentation patient would be considered as an Established Patient.


If you see a Medicare patient whom you have seen within the last three years, you must report the service using an established patient code.

On the other hand, if a lab interpretation is billed but no face-to-face encounter took place, the new patient designation might be appropriate.

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