Forum - Questions & Answers

Sep 9th, 2015 - JudyS

New vs Established patient in a Hospital Clinic setting

Hi,

I code for a hospital that has a pain clinic, wound clinic and chemo clinic. For each of these clinics we code/charge for the facility side of the visit. (UB04) If a patient is seen for the first time in the pain clinic but has a medical record number for hospital services and has had services, i.e. lab, xray, surgery, in the last 2 years, is our E/M level assigned for the facility a new patient or established patient?
OR does this only apply to physician service billing, i.e. (1500 bill).

Thank you,
Judy

Sep 11th, 2015 -

re: New vs Established patient in a Hospital Clinic setting

Patients registered as an inpatient or outpatient in the prior three years are established patients for the hospital.

Sep 11th, 2015 - Prakash.HB 2 

re: New vs Established patient in a Hospital Clinic setting

Well it depends on the NPI. Let me give you an example. Some critical access care hospitals will bill the claims under single NPI even though they are established in 3 or 4 places. If the patient visits any of this care for the first time and later visits the other he is an established patient. The claims will be filed under single NPI. UB claims are processed based on NPI, whereas in HCFA claims we have option to change the doctor's info for each line in block 24J. So if you are billing the claims for all the three i.e pain clinic, wound clinic and chemo clinic under single NPI then you can use codes related to established patient.

Regards
Prakash B R



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