General Question for the Week of June 19, 2017

General Compliance Question of the Week


My question is a follow-up to last week’s question and answer about Medicare’s definition of a new patient. Would a patient still be considered “new” if only a diagnostic test was performed?


Here’s what CMS says about this. If a professional component of a previous procedure is billed in a three-year time-period (e.g., a lab interpretation is billed and no evaluation and management [E&M service or other face-to-face service), then this individual remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E&M service or other face-to-face service with the patient does not affect the designation of a new patient.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.