General Surgery Coding Alert

Question: Our practice performed a test on a patient who was referred to us by another doctor. Our surgeon was not present for procedure; a technician administered the test. Should I consider this patient an established patient? Mississippi SubscriberAnswer: No, you should consider the patient "new" until a face-to-face encounter with your surgeon occurs. If the primary physician (or another physician billing under the same group number) provided a non-face-to-face service for a patient and then provided a face-to-face service within three years, you should still consider the patient to be "new" when selecting an E/M service code for the face-to-face service. According to AMA guidelines, there are additional factors to consider as well:The three-year rule is a well-established rule for "new" versus "established" patients. That is, if any physician within a given practice sees a patient within a 36-month period, that patient is considered "established".If visits occur outside of [...]