Changing Estb. to New

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Posts: 2
Joined: Wed Dec 14, 2016 10:21 am

Fri Mar 31, 2017 9:50 am

2 hospital providers of same surgical specialty in same group:
Dr. A saw the pt did an handwritten note, and the note didn't get scanned into the system
Dr. B saw the pt in followup.

I was asked by the practice administrator to change Dr. B's charge from estb to new to "recoup" the money lost on not billing Dr. A's charge since the note is MIA. Sent to Coding Director who advised to change the code from Estb. to New...(not documented not done). MY advice was to keep code as estb for Dr. B and have Dr. A dictate a notation that he saw the pt but documentation ran into IT snafu....

Which is correct?
Posts: 32
Joined: Wed Aug 17, 2016 6:02 pm

Wed Apr 05, 2017 2:21 pm

We have gotten guidance from Noridian that if the patient is there for an establish visit, you have to bill it as an establish visit. The patient is no longer considered a new patient. By what the manager and coding is saying, I feel they are "gaming the system" for financial gains.

As for provider A, he/she needs to dictate a note for legal reason, but we would follow the late entry guidelines from CMS that the provider must have had "total recall" in order to bill the new patient visit. Otherwise, the clinic will have to write off the cost.

I hope this help.
AHIMA Approved ICD-10-CM/PCS Trainer
Compliance Analyst
Posts: 2
Joined: Wed Dec 14, 2016 10:21 am

Mon Apr 10, 2017 2:32 pm

Thank you, Bill for the validation. :D
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