Internal Medicine Coding Alert
Established Patient Codes
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Question: A new patient calls for an appointment, but there are no openings in the schedule for the next two weeks. The office nurse gives advice on how to treat the patients complaint over the phone and follows office protocol of over-the-counter medicine, rest, etc. When the patient is seen in two weeks, should we charge a new patient visit or an established patient visit?
Pam Lindstron
Anaheim, Calif.
Answer: An established patient office visit, codes 99211-99215, is appropriate under these circumstances, according to Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a medical practice consulting firm in Broomfield, Colo. CPT guidelines state that a new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.
The internist should reference the service provided by the nurse over the telephone in his or her documentation when the patient comes in the office.
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