Wiki New vs Established if seen in ER

[avrilw]

We have a clinic and a hospital that bills under the same tax ID#. I bill for the professional clinic services and I am trying to find out if we would bill an established patient visit or new if the patient had been seen in the ER or as an inpatient in the hospital prior to being seen in the clinic. Thanks!

 

[CodingKing]

If its the same physician, they are established if they have had a face to face visit in the last 3 years regardless of setting or TIN. If its a different physician and the TIN is the same and it's a provider of the same specialty and subspecialty its established.