Pediatric Coding Alert

Reader Question:

New Problems May Not Mean New Patient Visit Codes

Question:  Our office saw a patient six months ago for a certain condition, and sent the patient back to his primary care provider for further treatment. The same patient was recently referred back to us for a different condition. Should we bill that patient as new, since he's coming back for a different reason? South Carolina Subscriber Answer: This patient should be considered "established" for many reasons. If you see a patient face-to-face any time within a 36- month period, that patient is considered established, regardless of the reasons for the visits. This is the AMA's "three-year rule." You should go by this rule even if another physician in your practice sees the patient, as long as it's within the 36 months. Location is not a factor either, in the event your practice has more than one location. Why: This rule applies as long as all the physicians in your group [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Pediatric Coding Alert

View All