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UCR 114: FAQs - New vs established patient; What services can nurses/MAs provide with no QHP present; Provenge billing clarification 

Available September 23, 2022

Mark, Ray, and Scott discuss Pediatric Urology Coding and some of its nuances.  Also, they answer 2 pediatric urology coding questions:

  1. I think the great majority of us know that if a patient has been seen by me or one of the other providers in my practice within the past three years then he/she is considered an established patient. However, there is some controversy in my new practice. I left hospital employment and started a new private practice. Some information suggests that because this is a new practice with a new tax ID and a new Group NPI number that any patient seen is considered a new patient. I wish that were true but I think that is incorrect and even though this is an entirely new practice any patient seen by me or my nurse practitioner in the past three years should be considered an established patient for coding and billing. Which is correct? Thank you.
  2.  I am needing clarification on if a patient can be seen by nurse/MA with no provider in office? Examples would be foley removals, phlebs, ua's, etc.  It was my understanding in the past we could not, but this issue came up recently when a doctor was ill and was not able to be in office.
  3.  Provenge billing: how many diagnoses? what about the Q codes - what's included?

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