Wiki Professional services (consultations) provided in a hospital setting

[asmith10982]

When professional services (such as palliative care consultation referral) are performed in a hospital (99221-99233) or home (99341-99355) setting, can the provider bill an initial or new visits (repeated), when the patient has been discharged and readmitted in either the home or hospital within a 3 year period?

Per CPT Evaluation and Management Services Guidelines, a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.

An established patient is one who has received professional services for the physician/qualified health care professional/another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past 3 years.

Initial services apply to the initial visit for an inpatient stay (hospital or nursing facility) performed either by the admitting physician or a consulting physician and these services do not designate whether or not the patient is new to the physician.

 

[thomas7331]

I think you've answered your own question here - the difference between 'initial' and 'new' are detailed in CPT. If the code descriptor indicates 'new', then in order to bill that code, then the patient cannot have been seen by that provider in the previous three years, in any setting. If the code descriptor indicates 'initial', then that code can be billed for the first visit during each admission, regardless of whether the patient is new or established.