Neurology & Pain Management Coding Alert

Question: A patient stopped receiving treatment from our office two years ago but recently returned for an evaluation and management service. May I report another new patient service? Also, can a nurse practitioner provide the care?


North Dakota Subscriber
Answer: No, you cannot report a new patient visit. When a patient returns to your office within two years, you should still use an established patient office visit code. You should continue to assign 99211-99215 until three years have elapsed since the last time you treated the patient in a face-to-face encounter, regardless of location.

The facts: -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,- states CPT's notes for new and established patients.

A nurse practitioner (NP) may provide the established patient service, but how you bill 99212-99215 depends on the insurer's incident-to policies. If the payer follows Medicare's requirements that the physician initiate treatment and see the patient on a regular basis, you should most likely report the E/M code using the NP's identification number.

Although Medicare does not define the frequency at which the physician must see the patient, two years could be considered beyond a feasible time to demonstrate the doctor's continuing involvement in the patient's treatment.