Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Article excerpt

New or established patients

I provided an E&M service to a hospital inpatient I'd never seen before. If he comes to my office for follow-up care, should I consider him a new patient or an established one?

You should report an established patient office visit (99212-99215) if you see the patient within three years of the hospital encounter. This is the case whether the patient is commercially insured or covered by Medicare. According to CPT, "an established patient is one who received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." Medicare defines "professional services" as an E&M service or other face-to-face service. So, since you provided this type of service to the patient, you'd consider him established if you see him again within 36 months.

How do the rules apply if you're in a group practice and the patient follows up with one of your partners? If your partner is in the same specialty as you, the patient would still be considered established. But if you belong to a multispecialty group, an office visit following a hospital encounter could qualify as a new patient service.

For instance, say you, an FP, see a patient in the hospital and recommended that he follow up with a gastroenterologist in your group. In this case, you could use the appropriate new patient code (99201-99205) for the patients visit to the gastroenterologist.

Modifiers with injection codes

I performed an E&M service for a 62year-old patient with a URI. Based on the history, exam, and medical decision-making, I decided to give her a penicillin injection. Should I append modifier -25 to the office visit code?

Yes. You'd attach the modifier when you perform a significant, separately identifiable E&M service in addition to the injection. For the injection administration code, use 90772 (therapeutic, prophylactic or diagnostic injection . …

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