tci Medicare Compliance & Reimbursement - 2007 Issue 39

REIMBURSEMENT: Don't Treat A Second-Hand Problem Like A New Development

Don't bill Medicare for routine pre-operative chest X-rayA problem may be new to your doctor, but that doesn't make it "new" for payment purposes, warns Part B carrier Palmetto GBA.A "new problem" is one that someone has identified but nobody has diagnosed, Palmetto says in a new Frequently Asked Questions (FAQ) answer on its Web site. A "new problem" may require an additional work-up to diagnose properly. But if a patient shows up in your office with a problem that someone else has already diagnosed, that's not a "new problem." You should score that visit the same...

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