Neurosurgery Coding Alert

Remember 3-year rule when addressing patient status
 
Are you having trouble separating new and established patients in your neurosurgery practice? If you are, know that coders who cannot tell the difference between the two can land their practice in a heap of compliance trouble with insurers.

Help's here: When you are unsure about a patient's status, take the AMA's advice and answer these five questions to determine definitively whether you should categorize a patient as new or established.

(Note: There is a flow chart in the latest CPT manual to help you decide whether a patient is new or established, under -Decision Tree for New vs. Established Patients- in the -Evaluation and Management [E/M] Services Guidelines- section of CPT 2007.)

1. Has the patient ever received any professional services from any physician in this group?

Yes: Go on to question 2.

No: The patient is New.

2. Has the patient received any professional service from a particular physician within the past three years who is now reporting service?

Yes: The patient is established.

No: Go on to question 3.

3. Has the patient received any professional service from a physician in the group of the same specialty within the past three years?

Yes: Go on to question 4.

No: The patient is new.

4. Has the patient received care from a physician of the exact same specialty within the past three years, or is a physician of a different subspecialty now providing care?

The providing physician is of the same specialty: The patient is established.

The providing physician is of a different subspecialty: Go on to question 5.

5. Does the current providing physician have the same tax ID as the physician who provided a separate service within the past 36 months?

Yes: The patient is established.

No: The patient is new.