Wiki Inpatient new vs established patient

[sluke9]

We are having a discussion about initial inpatient codes. Since they are for new or established patients, how do you make the determination which inpatient codes are appropriate?

1) If it is the initial visit by the non-admitting physician and consult code can't be billed, can you use the initial visit codes?

2) If it is the initial visit by the non-admitting physician and the patient is established to the physician can you use either the initial or subsequent codes?

Any input is greatly appreciated!!

Thanks,
Sheila

 

[csperoni]

Inpatient codes are not broken down by new patient vs established patient. They are for INITIAL hospital care or SUBSEQUENT hospital care (and inpatient CONSULTATION if the requirements are met and the carrier recognizes consult codes). All of the inpatient categories can be used for either new or established patients.
In both of your scenarios (provided 3 of the 3 requirements are met), that would be INITIAL hospital care since it was the initial visit by your provider/group to that patient during the admission.