Wiki Occupational Medicine office visits

[cberman]

Hope this makes sense...
Our office has an Occupational Medicine doctor who insists that other Occ Med doctors are billing all "new problem" office visits with 99202, 99203, etc. regardless if that patient is considered to be "new" by CPT definition or not. We have shown her the CPT book where it states that a "new" patient is one who is new to the practice or hasn't been seen for 3 years. She only sees work comp patients or employer drug testing, DOT physicials, etc. Does anyone have any input? Anyone out there have an Occ Med doctor who says the same thing? Thank you for any insight

 

[RebeccaCross*]

NC Industrial Commission has a different view of new versus established...

New Patient.
A new patient is one who is new to the physician or an established patient with a new industrial injury or condition. Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness..

Established Patient.
An established patient is a patient who has been seen previously for the same industrial injury or illness by the physician.

Now...when it comes to the actual workers comp carrier, they don't always follow the above guideline.

So yes...I have encountered the same scenario you are describing.

 

[cberman]

Thank you for your reply! This helps to point me in the right direction. Missouri WC law is difficult... no fee schedule and lots of rules to protect the worker, but not a lot to direct the providers. Thanks again!