# New/Established



## Tonyj (Dec 3, 2012)

Brain Freeze. 

Physician saw pt in hospital for consult. Pt comes to office 1 month later for visit. Would I code 99205 or 99215? I know the level.


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## cheermom68 (Dec 3, 2012)

Established


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## Naveen Rachagolla (Dec 4, 2012)

it should be New Patient, because the previously billed services by this physician when he did consultation, that bill might have been billed under Hospital Tax ID, But now the patient is comming to the physician office so this time it will be his own Tax ID unless that physician is not associated to the hospital. Because the CPT Book 2013, page #5 says..


Received any professional services from the physician or another physician in group of same speciality within the last three years, it should be exact same specialty and exact same subspecialty to be a Est.pt

And Page # 4 says..

A New patient is one who has not received any professional services from the physician/qualified health care professional of the *exact* same spacialty *and subspecialty *who belongs to the same group practice within the past three years.


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## dclark7 (Dec 4, 2012)

The patient would be established.  If the physician saw the patient in the hospital he has provided a "face to face" prefessional service so when the patient comes into the office he is no longer a "new" patient.  It doesn't matter where the first face to face encounter took place, the fact that one once provided is what determines new vs established.


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## Tonyj (Dec 4, 2012)

dclark7 said:


> The patient would be established.  If the physician saw the patient in the hospital he has provided a "face to face" prefessional service so when the patient comes into the office he is no longer a "new" patient.  It doesn't matter where the first face to face encounter took place, the fact that one once provided is what determines new vs established.



Thanks for everyones help. I do agree with dclark7 and cheermom68.


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## Naveen Rachagolla (Dec 4, 2012)

dclark7 said:


> The patient would be established.  If the physician saw the patient in the hospital he has provided a "face to face" prefessional service so when the patient comes into the office he is no longer a "new" patient.  It doesn't matter where the first face to face encounter took place, the fact that one once provided is what determines new vs established.




I nee some clarification on this...

If someone is going to audit this note, will he look for the previous bills ? because the NPI and TAX ID are part of billing.


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## MnTwins29 (Dec 5, 2012)

Naveen Rachagolla said:


> I nee some clarification on this...
> 
> If someone is going to audit this note, will he look for the previous bills ? because the NPI and TAX ID are part of billing.



When I audit, I don't look for bills - I look for either previous progress notes or clues in the current note (i.e. follow up from 2/28 hospital visit)


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## mitchellde (Dec 5, 2012)

Naveen Rachagolla said:


> it should be New Patient, because the previously billed services by this physician when he did consultation, that bill might have been billed under Hospital Tax ID, But now the patient is comming to the physician office so this time it will be his own Tax ID unless that physician is not associated to the hospital. Because the CPT Book 2013, page #5 says..
> 
> 
> Received any professional services from the physician or another physician in group of same speciality within the last three years, it should be exact same specialty and exact same subspecialty to be a Est.pt
> ...



When the physician sees a patient in the hospital inpatient or outpatient setting it is not billed under the hospital tax ID or NPI.  It is still billed under the physician just the POS is the hospital and the hospital addreess and NPI is in field 32 for location of service but the physician address and NPI is in field 33 for the billing address.  Therefore when a provider sees a patient in the hospital as a new patient, they are then established when they subsequently see them in the office.


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## Naveen Rachagolla (Dec 5, 2012)

mitchellde said:


> When the physician sees a patient in the hospital inpatient or outpatient setting it is not billed under the hospital tax ID or NPI.  It is still billed under the physician just the POS is the hospital and the hospital addreess and NPI is in field 32 for location of service but the physician address and NPI is in field 33 for the billing address.  Therefore when a provider sees a patient in the hospital as a new patient, they are then established when they subsequently see them in the office.




Thank you for clearing it.


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