Wiki NEW vs EST patient

[mhissy18]

Hello,

I am new at E&M coding. There is a confusion at our office (esp. requesting authorization) whether to bill E&M as new vs est patient. A patient had an ultrasound at our office and the doctor interpreted the report (with no face-to-face with patient). Then, patient returned for another ultrasound and this time, the doctor had a face-to-face with a patient. Does this mean the patient is established? or does this visit still considered as a new patient visit?

Thank you,

Grace, CPC

 

[Cynthia Hughes]

new vs. established

Hi,

The patient is new in your scenario unless another physician of the same specialty and same group practice has provided a face-to-face service to the patient within the past 3 years. The non-face-to-face service of interpreting an ultrasound or other test does not make the patient an established patient. You can verify this in the E/M guidelines of your CPT manual which includes "face-to-face" as a qualifier for the services within the past 3 years.

Hope that helps.
Cindy