tci General Surgery Coding Alert - 2011 Issue 11

Reader Question: Established Patients Last 3 Years

Question: We saw a patient over a year ago for a hemorrhoidectomy, and now the patient came back with extreme lower right quadrant pain and our surgeon performed an appendectomy. Should we  bill the appendectomy as a new patient since he's coming back for a different reason? Idaho Subscriber Answer:  No, you should not bill this case as a new patient. You should bill this as an established patient for several reasons. If your surgeon sees a patient any time within a 36-month period, that patient is considered established, regardless of the reasons for the visits. This is the...

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