Otolaryngology Coding Alert

Question: My physician saw a patient in the emergency room in 2001. That same patient just presented to our office for his first service with the same physician who treated him during the emergency. Should we code this office visit as an established patient because of the ER service, or can we code a new patient office visit?

Georgia Subscriber

Answer: This is a very interesting situation, which can be resolved with this steadfast rule: If you provide services for a patient anywhere within the last three years, the patient is considered an established patient.

The rules: According to CPT guidelines, "A new patient (99201-99205) 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. An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years."