Coding

  • 1.  New Patient?

    Posted 09-29-2021 19:32
    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 09-30-2021 17:42
    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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    Original Message


  • 3.  RE: New Patient?

    Posted 09-30-2021 18:31
    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.


    Original Message


  • 4.  RE: New Patient?

    Posted 10-02-2021 12:15
    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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    Original Message


  • 5.  RE: New Patient?

    Posted 10-20-2021 19:19
    Thanks for the info - that will make things a lot easier.  
    I'm wondering when the patient has her next visit for fetal growth assessment and evaluation of her underlying diabetes or hypertension, can I assume that those same codes [outpatient consultation codes (99241-99245)] apply as long as I provide a written report?
    Thanks again
    Dr Jeffrey King



    Original Message


  • 6.  RE: New Patient?

    Posted 10-20-2021 19:57

    Good evening,
    For follow-up visits, these are considered established patient visits 99212-99215.

    Remember that consultation codes 99241-99245 require a request for opinion and/or advice, as well as the written report back to the requesting provider. Any subsequent consultation would require another request for opinion and/or advice, in order to be billed with a consultation code.

    Thank you,
    Trish



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