Wiki E/M question in regards to physican chaning practices

[jennifersellards@hotmail.com]

We are seeing denials because we had a physican that worked at one practice and he is now with another pracitce. Some of his patients are now being seen at this new practice. We are using the new patient E/M codes because these are new patients to this practice but these are coming back as being denied. Can we not bill these as new patient visits? If this can be billed this way how to we get these paid? Do we appeal this?

 

[Monika Liddle]

Per PCT EM service guidelines - "a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty or subspecialty who belongs to the same group practice, within the past three years"

It does not matter that the physician is new to your facility, if the provider has seen the patient in the last three years, they are considered established.