Gastroenterology Coding Alert

Question: A patient shows up at our office complaining of nausea. A gastroenterologist at our branch office across town saw her seven months ago. Do I code her as a new patient?

Arizona Subscriber

Answer: If the same physician or other physician of the same specialty billing under the same group number sees the patient at any time within a three-year timeframe, you must consider the patient established, even if different gastroenterologists at different locations saw the patient.

In this case, the patient is established, even though the encounters took place at separate locations and involved separate physicians.

Here's why: Because the physicians are of the same specialty and bill under the same group number, the three-year rule applies.

Had the doctors been of different specialties -- or if they billed under different provider numbers -- the second physician may have been able to report the patient as new, as long as the doctor hadn't seen that patient within the previous 36 months.