Wiki New pt documentation

[songstresspyt@yahoo.com]

I have a question....I have a proivder that is billing for new pt appointments but isn't stating in her documentation that the pt is new or est. Does the provider need to state in her documentation that the pt is new if she is billing a new pt e&m code???

Kristi

 

[MnTwins29]

Not needed

As long as the patient meets the new patient qualifications (has not recieved services from the physician/qualified health care professional OR another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past three years) - then the visit could be billed as a new patient visit.

 

[songstresspyt@yahoo.com]

Thanks Lance!

 

[MikeEnos]

Agreed - there is no need for the provider to explicitly state that the patient is new in order to get credit for a new patient visit. The most important thing is that they really ARE new - so not seen by the provider (or any other provider in the same group with the same specialty) within the last THREE years.

Note: non face-to-face services may flag the patient as being seen (insurance may deny a new patient visit), but only face-to-face services reset the 3 year clock. In other words, if the patient hasn't been seen in 5 years, and the doctor does the interpretation and report on a stress test before seeing the patient the next day, they are still a new patient since reviewing the report is a non face-to-face service.