General Surgery Coding Alert

Question: We saw a patient over a year ago for a hemorrhoidectomy, and now the patient came back with extreme lower right quadrant pain and our surgeon performed an appendectomy. Should we  bill the appendectomy as a new patient since he's coming back for a different reason? Idaho Subscriber Answer:  No, you should not bill this case as a new patient. You should bill this as an established patient for several reasons. If your surgeon sees a patient any time within a 36-month period, that patient is considered established, regardless of the reasons for the visits. This is the AMA's "three-year rule." You should go by this rule even if another physician in your practice sees the patient, as long as it's within the 36 months. Caveat: This rule applies as long as all the physicians in your group bill under the same group number. Location is not a factor [...]