Wiki Initial or Subsequent Code?

[lplascak11]

Hello, I bill/Code for a Family Medicine Residency. The residents see the patients in a hospital setting and then the attendings supervise them. But they also work in a clinic setting as well. So the question was brought up that if a patient is in the ER for a concussion and is treated and sent home and told to follow up with PCP in a clinic setting would that charge be a subsequent charge or Initial for the clinic visit? For additional information the patient wouldn't necessarily be seen by the same doctor at both locations although that can happen depending on the residents rotation. Usually it's an ER doc and then the follow up by another doc. They are different Tax id's and NPI numbers so I would think that it would be initial since this would be the first time the Clinic doctor is seeing the patient from the ER visit with the ER doc but for the same concussion. Thank you in advance for clarification.

 

[thomas7331]

To start with, your question is rather confusing because it sounds like you're talking about new vs. established, not initial vs. subsequent? Initial and subsequent terminology only applies to hospital visit codes during a given admission.

If you're asking if the clinic visit should be new or established, then you would have to look at the provider and specialty that was billed for the visit that took place in the hospital. I'd assume you're billing the claim under the supervising physician, so that's the physician you'd need to consider for that visit. Then if the physician who sees the patient in the clinic at the next visit is of the same specialty and works for the same practice as the practice as the physician who billed for that visit in the hospital, then it's going to be an established patient visit.