Wiki Auto Insurance and E/M Codes

[lindalouise55]

Hello everyone. I have a situation that I have not had in a long while and am unsure what to tell the doctor. The patient is an established patient with the practice but the visit we are seeing him for today is to be billed to Auto Insurance instead of Medical insurance. The question Is this patient a new patient to the auto insurance or established since he is established with the practice? The confusion is that the U.S. Department of Labor states that a worker's comp patient even if established with the practice would be a new patient for a new injury.

Just very confused and want to tell the physician the correct answer. Any one have a clue?

 

[LLovett]

As far as the CPT definition of a new patient, insurance payer does not factor into the decision making at all.

Unless otherwise directed by the payer, as in the case you sited with workers comp, I would advise defaulting to the definition in CPT.

In which case the patient would be established.

Just my take on it,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC

 

[lindalouise55]

Thanks

Thanks Laura. This is what I was thinking but we have a particular provider who wants everything in black and white so I was asking for that reason.