Neurology & Pain Management Coding Alert

Question: A new physician has just joined our group, and some of his patients will now see him in our office. These patients are new to our group, but not new to the physician. Should we consider them new or established patients?

Indiana Subscriber

Answer: According to CPT guidelines, you consider a patient "established" if she has seen the physician within the past three years. Although the patients are new to your group, they won't all be new from a coding perspective.

Caveat: Part of the new patient/established patient distinction lies with the physician. If he keeps his old billing number, the patients will be "established"; if he bills under a new number the patients will be "new." Verify which number your physician uses to help determine the correct code set.

Report established patient visits for any patients the physician has seen within the past three years with 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient -).

If more than three years have passed since the patient saw the physician, code a new patient visit with 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient -).

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.