Pediatric Coding Alert

Question: A pediatrician recently joined our group practice. Several patients are transferring to our practice to continue seeing her. When the children come in, should I report the visits as new or established patient office visits?

Florida Subscriber
 
 Answer: You should report the encounters as established patient office visits (99212-99215, Office or other outpatient visit for the E/M of an established patient ), if the pediatrician has seen the children within the past three years. The established/new patient rules refer to the patient-physician relationship, not the patient-practice relationship. An established patient 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, CPT states.

Therefore, if the transferring pediatrician has provided professional services to the patients in any location in the past three years, you should report the encounters as established patient visits. Whether the child is new to the location or practice is irrelevant.