General Question for the Week of June 19, 2017

Question:

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?

Answer:

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.