Wiki New or Est.

[samyjm13]

Our clinic is associated with our hospital. One of our physician from that clinic delivered a baby at the hospital, and later the mom brought the baby in for a well child exam. It's first wc exam. I coded it as a new patient. The insurance denied it because they are saying it should have been coded as an established pt. Since our clinic is associated with the hospital and the doctor is one of the physicians there, and he did the delivery, would the exam be new or est.?

Jeanne

 

[rthames052006]

Our clinic is associated with our hospital. One of our physician from that clinic delivered a baby at the hospital, and later the mom brought the baby in for a well child exam. It's first wc exam. I coded it as a new patient. The insurance denied it because they are saying it should have been coded as an established pt. Since our clinic is associated with the hospital and the doctor is one of the physicians there, and he did the delivery, would the exam be new or est.?

Jeanne[


If the clinic and the hospital share the same tax id# then yes, the visit to the clinic for the well child visit would be established. There is actually a great thread on this topic under e/m I believe.

 

[samyjm13]

Thank you!

Jeanne