Practice Management Alert

After 3 years, familiar faces are new again

If you want to get off on the right foot in 2006, you should heed a recent transmittal from the CMS, which clarifies some important rules for new patient evaluation and management billing.

In transmittal 731, CMS fine-tunes its definition of -new patient- for E/M coding. Experts say the policy hasn't really changed, but CMS is explaining it differently, which should make things clearer.

The lowdown: Someone is a new patient if none of your physicians have seen her face-to-face in the past three years, according to the CMS transmittal. So if one of your physicians interpreted a patient's test results or did some other non-face-to-face service in the past three years, you can still consider that person a new patient if she comes into the office, says consultant Devona Slater with Auditing for Compliance & Education in Leawood, Kan.

Example: A cardiologist performed an EKG interpretation for Patient Q but provided no face-to-face service during an emergency department visit three weeks ago. Today, Patient Q reports to the same cardiologist for a level-two E/M service.

Since the cardiologist did not see the patient for the EKG interpretation, you could still bill a new patient E/M code for the visit, says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J., and a member of the National Advisory Board for the American Academy of Professional Coders.

On the claim, you should bill 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; straightforward medical decision-making) for the visit.

Remember: The -new patient- rule applies to physicians in the same practice who are also of the same specialty, says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the AAPC National Advisory Board. If your practice is big enough and covers enough specialties, you may have two physicians see a patient for completely different reasons, Parman says.

For example, -if there is a large multi-specialty group and the endocrinologist sees the patient this year, but the cardiologist sees the patient next year--both are new patient visits,- Parman says.