Forum - Questions & Answers

Jul 16th, 2015 - tmangham

New pt vs Estab pt

I work for a group of surgeons. They are all part of the same specialty and share same tax id #. We have a patient that came in December 2014 and we billed for new pt exam. Then same patient came back in June 2015 and seen a different doctor in our practice (same specialty, same tax id#) and pt was billed again for new pt exam. My question is shouldn't the 2nd exam-office visit be billed as an established patient?

Jul 16th, 2015 -

re: New pt vs Estab pt

That is correct and it is in the CPT® guidlines in the CPT® section of E&M's. there is a chart to show how to determine a NP to EST pt. Your drs are committing fraud by billing that way. Read the guidelines to them so they get better idea of how to distinguish between the two:)

Jul 16th, 2015 -

re: New pt vs Estab pt

Established PT code should be billed. Because the PT is visiting the same specialty for second time.



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