Wiki New pt E/M code for same Provider, different Billing NPI's

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sibylle

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Hello,

If someone could please help me with this problem I would be very appreciative.

Here is my problem, I am working for a PCP, he also owns an Urgent Care. Both offices have different billing NPI's. The pt was seen on the Family Practice side as an established pt. A few weeks later, the same pt visited his Urgent Care and a New pt code was billed.

I advised the office manager that per coding guidelines this was not an acceptable practice. I even showed her the May issue of Healthcare Business, where this subject was discussed and it clearly stated that this can not be done.

The office manager than called another coder and was advised that the article is wrong. I've attempted to get clarification from the Medicare contractor, however, they were unable to provide me with a link.

Is anyone able to provide me with a link so I may show my office manager, that although the pt is seen in 2 separate locations, we can not bill a new pt E/M twice.

Thank you in advance for your help

Sibylle Friberg, CPC
 
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I had to look this up today, good timing....

Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years.

For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit.

An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

https://questions.cms.gov/faq.php?id=5005&faqId=1969
 
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