Wiki New Patient and Established Patient

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himani17

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If the specialist has billed only procedures such as abi or ad performed at satellite site. Does the specialist bill a new visit next time the patient comes to the specialist?
 
If the patient has had any procedures from the specialist, they are not a new patient. Yes, if you do a procedure without a new patient visit first, you miss out on billing a new patient visit.
 
himani17 said:
If the specialist has billed only procedures such as abi or ad performed at satellite site. Does the specialist bill a new visit next time the patient comes to the specialist?
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Technically, the patient becomes established only by a face-to-face service. If the specialist is just performing the interpretation and report of a diagnostic study such as an x-ray, that does not establish the patient. However, this may vary a bit from payer to payer.
 
The technician from the specialist office will perform the procedure such as abi and ad and after reviewing the specialist bill the only the procedures for the patient. So I believe there's no face-to-face contact with the specialist so far. The patient is scheduled at the specialist for further evaluation. That's when the first f2f encounter takes place.
 
The specialist is billing for a technician's services as if they performed them themself? Do these services have a technical and a professional component?
 
himani17 said:
The services are performed by the technician. and reports have technical and professional components.
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Under CPT guidelines, these services would not make the patient established to the provider because there was no face-to-face encounter with the physician. But again, not all payers are going to see it that way. I would bill it as a new patient, but if it's a commercial payer it's possible that it will be denied and need to be either appealed or resubmitted with an established patient code.
 
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