Coding

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New Patient?

  • 1.  New Patient?

    Posted 18 days ago
    Hi
    I may be mistaken, but I thought that all office E&M services within 3 years are considered "Established Patients".
    However, can the first MFM Consultation in a new pregnancy be coded as New/Initial Consultation even within that 3 year period?
    Thx

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    Jeffrey King MD
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  • 2.  RE: New Patient?

    Posted 17 days ago
    Hi Dr. King,

    From my experience in Revenue Cycle Management, I believe that the definition of established is any patient that was seen within the last three years - and for Medical Groups, an added layer is "of same TIN and same specialty". Therefore, as long as your MFM Provider is credentialed with the payer as MFM, and not OBGYN only, they are able to bill for a new patient visit even under the same TIN.

    I hope this is helpful!

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    Arianna Fugit
    Sr. Manager, Financial Sustainability
    Unified Operations of NY
    arianna.fugit@unifiedhc.com
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  • 3.  RE: New Patient?

    Posted 17 days ago
    Since the requirement for a consultation is that another provider sends you a request for a consultation, you may indeed do a consultation on a patient that you have seen in the past 3 years. Note that the referring provider cannot be sending you the patient as a transfer of care. They must explicitly ask for a consultation.




  • 4.  RE: New Patient?

    Posted 15 days ago
    Hello,
    Outpatient consultation codes (99241-99245) do not have new/established requirements attached to them, per CPT. They are for new or established patients, when your opinion/advice are requested by another health care provider, and you provide a written report to the requesting provider.
    Thank you!
    Trish

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    Trisha Malisch, CPC, CCS-P
    Lead Coder
    SMFM Coding Committee
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