Anesthesia Coding Alert

Question: We hired a new physician for our practice after another doctor left. The patients are not new to the practice. How should I code patient follow-ups to new physicians within the same practice?

Colorado Subscriber

Answer: CPT rules clarify that patients are considered to be established if they have had a face-to-face professional service with the provider or a provider of the same specialty in the same group practice within the past three years. The follow-up visits with your new physician would be reported with an established-visit code, 9921x (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ...)

Take note: A patient could be considered new if neverseen by a provider of the same specialty within the past three years even though they have seen different specialty physicians in a multi-specialty group within the past three years. (See decision tree in front part of CPT book.)

Outpatient consultation codes (99241-99245) are not affected by new or established patient criteria. If your new doctor is asked for his opinion or advice about a patient from an appropriate referral source, and all consult requirements are met, then it would be appropriate to bill 9924x (Office consultation for a new or established patient, which requires these 3 key components ...)