New versus Established Patients

We’ve updated this frequently asked question based on recent clarification from CMS.

3. Please clarify appropriate billing for outpatient/office services when a consulting provider has already performed a service for the same patient in the inpatient or ED setting.
   
   Answer: ED services and initial inpatient care services are included within the three-year lookback period for billing new patient services in the outpatient/office setting. For example, a cardiologist may see a patient during a hospital stay and bill an initial inpatient care service (99221-99223), when the cardiologist subsequently sees the patient in the office setting, the office service would be billed in the range of 99212-99215.

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Posted 5/5/2023