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Thread Topic: New patient billing

Topic Originator: Subhash
Post Date August 16, 2013 @ 5:35 PM
New patient billing New patient billing

New patient billing

New patient billingAugust 16, 2013 @ 5:35 PM Reply  |  Email Friend   |  |Print  |  Top


Can i bill a patient as new patient where the physician has split from his old group as is now has his own practice. This patient was seen by this physician earlier.


New patient billingAugust 20, 2013 @ 7:23 AM Reply  |  Email Friend   |  |Print  |  Top

Sure, we usually bill a 99205 or 99255

Joan Gilhooly
New patient billingAugust 29, 2013 @ 4:46 PM Reply  |  Email Friend   |  |Print  |  Top

No, you can't if the physician has seen the patient in any setting of care within the past 3 years.

The CPT manual defines a new patient for you.  On page 4 of the 2013 manual, it tells you that a new patient is one who has not received any professional services from this physician - or from another physician of the same specialty in the same group practice - within the past 3 years.

The fact that the doctor split from his old group and now has a new practice doesn't even enter into the equation.

Hope this helps!

New patient billingAugust 29, 2013 @ 4:53 PM Reply  |  Email Friend   |  |Print  |  Top

Thanks Joan for clarificaton,

i thought similar since the patient was following the  dr. to new pratice.

New patient billingAugust 30, 2013 @ 6:27 AM Reply  |  Email Friend   |  |Print  |  Top

When a patient comes to us and we never saw them in our building, we bill 99205 or 99255.  

If we never saw them for their complaint, we bill 99205 or 99255.  To get paid we use modifier 59

New patient billingSeptember 4, 2013 @ 6:19 AM Reply  |  Email Friend   |  |Print  |  Top

No you can't bill an old patient as a new patient because a new patient is the one who never received any healthcare service from this physician.

New patient billingSeptember 8, 2013 @ 6:47 PM Reply  |  Email Friend   |  |Print  |  Top

Why cant you bill  99205?  We do it all the time with every patient and we get paid.  If we get paid, we must be doing something right.  So, we bill 99205 and sometimes 99255.  99205 and 99255 are valid and current CPT codes and the insurance company pays them.  They wouldn't pay a code that was wrong.  Ive been doing this for 10 years and never had a problem.  Its how we've been doing it in our office for years.  If we can do it, so can anyone else.

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