Gastroenterology Coding Alert

Question: My gastroenterologist met with a patient in the office at the patient's request (in other words, the service is not a consult). Although the gastroenterologist has seen the patient in the  past, the last visit occurred more than four years before. How should I code for this encounter?

Utah Subscriber

Answer: In this case, you should consider the patient new rather than established. Therefore, you would choose a code from the new patient outpatient services category (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient...), rather than the established patient outpatient services category (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient...).

Here's why: The reason this patient is new is because the gastroenterologist hasn't seen the patient in the past three years. If the physician, or any physicians of the same specialty billing under a common group number, has not seen the patient within the past 36 months, you can consider the patient new. However, in order to assign the new patient codes, the documentation requirements for new patient visits must be met.