Wiki Established patient & Outpatient Surgery

[pkidd]

My surgeon wants to know why she cannot bill a new patient/hospital outpatient code [99204] on a patient that she had seen (outpatient status) at the hospital. She did an H&P and immediately took patient to surgery for an incarcerated hernia. The patient remained in Outpatient status with an overnight stay, going home early the next day.
Surgeon had been seeing patient a few times a year for chronic pressure ulcers.
Thanks for the assistance
pat kidd

 

[AmandaBriggs]

99204 is a new patient code. Per CPT, "A new patient is one who has not received any professional services from the physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." If the patient is established with the provider then established E/M codes should be used. If the physician admitted this patient to observation status at the hospital, then an observation E/M code may apply.