This was a very well written reply. However, if our cardiologist reads an ekg or stress test while the patient is inpatient, then said patient is a follow up with same cardiologist in office after discharge, we bill as established as payer rejects (BCBS specifically) kept happening due to the same tid, same provider has already submitted a claim for said patient.
Then I would appeal with a photocopy of the CPT book, as it clearly says "face-to-face" services.
Dear BCBS:
(Introductory stuff identifying patient and claim)
On XX/XX/XX, John Smith MD was called upon to read an EKG for your member, FIRSTNAME LASTNAME, who was inpatient at XXXXXX Hospital. Dr. Smith did not evaluate the member, did not perform any face-to-face professional services with the member, and in fact, did not even meet the member.
Subsequent to the EKG reading, the member was seen in the office on XX/XX/XX and became our patient. We billed 99205, (type out definition). You then denied that claim stating the patient was an established patient and not a new patient.
According to the American Medical Association's CPT 2020 Professional Edition, Page 4, a new patient is one who has not received any professional services.... (type it out), and "professional services" is defined as ... (type it out). You are required to abide by the CPT (Current Procedure Terminology), as the Health Insurance Portability and Accountability Act determined that these codes were the official codes to be used in all transactions. The American Medical Association owns the copyright of these codes, and the definitions are set therein. The definitions are not subject to change.
Clearly you have erred in denying our claim, as this patient was not a new patient until the in-office visit of XX/XX/XX. We have attached the denied claim. Please reprocess and pay our claim. You may also pay any interest owed by law (insert a reference to your state law if there is one for timely payment), as you had a clean claim in your possession on XX/XX/XX.