Wiki Echo

[dimme85]

Would an Echo exam be considered a face-to-face professional service, for the sake of determining if the patient was new or established? The scenario is that patients often have an Echo ordered by another specialty. Then after the Echo, the Cardiologist may see them a week or so later.
Our Cardiologist want to code that as a new patient, but we feel since they have already provided a face-to-face professional service, that patient is now established in Cardio.

 

[Cyndi113]

Unless the physician is actually performing the echo, it would not be considered a face to face service.

 

[dimme85]

When submitting the original bill to Medicare, how would they know that it was not the Cardio that was actually performing the service? The bill to them would indicate the Cardio as the provider, and not the tech.

Not trying to split hairs here, just trying to make sure I can give our docs a good answer because they are really pushing on this one.

 

[OliviaPrice]

I would contact your local carrier and ask them the question. Our local does not consider this a face-to-face encounter even if the provider performs the echo. This is because no actual evaluation/assessment of the patient occured.

 

[dimme85]

We contacted our carrier, Palmetto (twice since sometimes you get different answers) and they told us that if we billed a global Echo, then we would not be able to bill a "new" on a subsequent visit.

 

[OliviaPrice]

If your physician is not the ordering physician and is not performing the actual study I would make an argument that the office visit should be considered a new patient. The physician is not actually seeing the patient face to face and is not performing any type of evaluation/management of the patient.

However…..if your physician is ordering the echo prior to the initial visit just to make it easier and so s/he can give the results to the patient at the time of the visit, I would inform your physician(s) that this practice is losing them money. In most carriers eyes the physician would have to evaluate the patient's records in some way to determine that an echo was necessary.