Does anyone know if a patient has a echocardiogram in the doctor's office previous to being seen as a new patient - can a new patient code be used? I was told at a seminar that it could be billed as new patient when a previous echocardiogram was done because the echocardiogram is not considered "face to face" by coding guidelines. I cannot find any specific reference to this. There is no physician supervision required for an echocardiogram. I know if a patient had a previous stress test, then the patient is considered an established patient for followup. Supervision requiried for stress.
Per Medicare Claims Processing Manual chapter 12, Section 30.6.7 defines a new patient fist as:
A Definition of New Patient for Selection of E/M Visit Code
Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 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.
According to the Centers for Medicare and Medicaid Services (CMS), a new patient is a patient who has not received any
professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.
CMS clarified their definition of a New Patient Visit. As you can see in the above exert; the definition specifically states that diagnostic test 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.
HTH, Misty Sebert CPC, CCC
