Primary Care Coding Alert

Question: A child's parents stopped her treatment with our office two years ago. Last week, the patient and her parents reported to the office for treatment. The physician performed a level-one evaluation and management service on the child. May I report another new patient service?

New York Subscriber

Answer: No. When a patient returns to your office within two years, you should still use an established patient office visit code.

Report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) for the service.

In fact, you should continue to assign established patient E/M codes until three years have elapsed since the last time you or another physician of the same specialty in your group treated the patient in a face-to-face encounter, regardless of location. -A new patient 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,- states CPT's notes for new and established patients.