Wiki New or Established Patients

[mauikidneydisease@mac.com]

We have three solo physician nephrology practices, each with unique Tax ID numbers, who provide hospital coverage for each other. We see each other's patients in the hospital. The question is whether to consider the patient as a new or established patient when a H&P or consult is performed. Patients may include dialysis patients. After an online search, I found this guidance:

"When one group provides coverage for another physician group, the patient encounter is classified as it would have been by the physician who is not available. For example, let?s say your practice provides coverage for a solo physician in your community. While the physician is out of town, you see one of her patients. As long as the physician who is out of town has seen the patient in the last three years, you have to report the service using an established patient code. This is true even if you are unfamiliar with the patient, clinical information is not available and the office staff does not have basic demographic information."

Do you agree with this guidance? Are there exceptions?

Thanks.

 

[Herbie Lorona]

Yes that is the way they have it worded so if you are covering for another Dr. they are considered an established patient.

 

[jlgeddings]

We share hospital call coverage with another practice and bill their patients as established, even though we have never treated them in the office before. It is my understanding that as long as the patient is current (i.e. seen within the last three years), then a covering physician has to bill as established.

 

[mauikidneydisease@mac.com]

Thanks for replies!