Podiatry Coding & Billing Alert

Question: Our office recently had a patient referred to us for treatment for a condition after his first visit to our office for a completely different reason about a year ago. After the first visit, we sent him back to his primary provider for further treatment; since this is a new condition unrelated to the first visit, should we bill him as a new patient?

Maine Subscriber

Answer: You can consider this patient to be established, following the AMA’s three-year rule. Your office should consider a patient to be an established patient if one of your providers treats the patient at any time within a three-year period. This applies to all physicians within your practice and also to all locations, in the event that the practice has multiple offices, as long as all the physicians in your group bill under the same group number.

That said, the rules change a bit if you are operating in a multi-specialty practice. If a non-podiatry physician sees him for the first time, you can bill him as new even if he has seen other physicians in other specialties within the group practice during the previous three years.