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Two Visits, Same Patient, Same Day, Different Insurances

Question: If a new patient comes in to be seen by a doctor for work comp and is also seen as a regular patient, can they be charged as a new patient on both encounter forms, even if it is on same day?? One is work comp insurance and the other is patient's health insurance.

Answer: Per the CPT rules, a person is considered a new patient for a physician based on one criteria, that being that a patient has received any professional service from a physician, or another physician in the group, of the same specialty, within the last three years. So, assuming that your physician is a family/general practice physician, it doesn't matter whether the patient is coming in for a cold or worker's compensation, it's still the same physician and therefore any subsequent visit would be as an established patient.

The rule would be even more clear if it were on the same day. That the insurances would be different doesn't make a difference when it comes to the rules; if it can't be done with the same insurance company, it can't be done with different insurance companies, or different types of insurance companies either.

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