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Gastroenterology Coding Alert

READER QUESTIONS:

New Gastros May Bring Established Patients

Published on Wed Oct 17, 2007

Question: We have a new gastro physician starting at our clinic this month. She is coming over from a nearby county, so of course she has her own patients who will be following her. Should we charge her patients as new, or will they be established because she has seen them? She was practicing and billing under another tax ID and will be changing to ours when she starts.


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Answer: If your new gastroenterologist or any other physician of the same specialty has seen the patient within a three-year timeframe, you should count the patient as an established patient (99211-99215).

If your new gastroenterologist or any other physician of the same specialty in your practice has not provided any professional services to the patient in the past three years, you should consider the patient new (99201-99205). Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.
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