Wiki New vs Established Patient

[jmcalhaney]

I have a question and was wondering if anyone would be willing to give their opinion. I am trying to decide whether a new patient or established patient visit should be billed in the scenario: Dr. A sees Patient John Doe in the Wound Care outpatient clinic. A new patient visit is billed for John Doe. 3 weeks later, Dr. B is covering for Dr. A at the wound care clinic and sees John Doe. Dr. B is trying to bill John Doe for a new patient visit as well because she is not part of Dr. A's group. Both Dr. A and Dr. B see patients regularly at the wound care clinic. They are both also independently contracted through the hospital.

I am aware that if you are covering for a physician, then you should bill it as if the physician you were covering for saw the patient herself. I am being told by the doctors that the patient should be billed as a new patient for Dr. B. I am skeptical of this and wonder if anyone has any guidance.

 

[whawker]

New/Established Patient

Dr. B. has the benefit of medical notes and so forth from the patient's having been seen the first time by Dr. A. Therefore, Dr. B., if it were a new patient, would have to perform the work of obtaining H & P, PE, determining indicated diagnostic orders, etc., which is why the reimbursement is higher for a new patient. The patient is not new to care being provided by the center, regardless of the doctor (you might say that is why the code is "new" versus "establshed" patient --- not doctor) --- otherwise, everybody would be getting into the act! Good luck.