Wiki Please help!

[cherylbr]

Can I bill for an NEW PT E&M in the following scenario?

dos 12-01-18 patient seen for visual field test provided by the office technician and billed under dr & group NPI #.

dos 12-04-2018 patient present and see's doctor for new pt encounter with review & reading of visual field test that was provided on 12-01-18. This visit is also being billed under the dr & group NPI #.

I am not sure if since the claim was submitted for dos 12-01-18 with the same NPI # that I can bill a new patient visit/e&m for dos 12-04-18. What is the proper way to submit this and report the new patient code?

Thank you!
CBrooker

 

[Chelle-Lynn]

Per CMS...

Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) 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., lab interpretation) 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 electrocardiogram (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.

 

[Cheezum51]

I'll repeat my query from another thread on this subject. How can the doctor order a fields test prior to even seeing the patient? There has to be an order some place specific to this patient written by the doctor but you state the patient wasn't actually seen until 3 days after the fields was done?

Tom Cheezum, O.D., CPC, COPC

 

[MSCALLIE79]

Per CMS...

Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) 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., lab interpretation) 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 electrocardiogram (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.

I agree this happens a lot at my practice due to scheduling issues.