I am hoping someone can shed some light on this one.

Our doctors interprets pulmonary function tests for the hospital. Last year, the hospital sent one of our doctor’s a pulmonary function test on a patient to be interpreted, the patient was not one our patient. There was no face to face, just an interpretation. The interpretation was billed with the 26 modifier and paid. This year the patient came in to see one of our doctors for the first time. We billed a new patient visit, however the insurance company, a Medicare replacement plan, continues to deny the claim stating a "new patient code" is inappropriate.

I have sent two appeals already and they continue to advise to resubmit a corrected claim because the "new patient code" is inappropriate. Am I missing something here?

Thank you,

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