From the Research
Yes, you can bill for a new patient E&M code in this situation. According to coding guidelines, a patient is considered "new" if they have not received any professional services (face-to-face services) from you or another provider of the same specialty in your group practice within the past three years. While the patient had a TB test ordered through your clinic last year, this does not constitute a face-to-face encounter if the patient was not actually seen by a provider. The TB test order alone is considered an ancillary service, not a professional service that would reset the three-year clock.
When billing, you should use the appropriate new patient E&M code (99201-99205, depending on the complexity of the visit) and document thoroughly to support the level of service provided. Remember that new patient visits typically require all three key components (history, examination, and medical decision making) to meet or exceed the level billed, unlike established patient visits which require only two of the three components.
The provided studies 1, 2, 3, 4, 5 do not directly address the question of billing for a new patient E&M code, but they do provide information on tuberculosis testing and diagnosis. However, the key factor in determining whether a patient is considered "new" for billing purposes is the presence or absence of face-to-face professional services within the past three years, not the ordering of ancillary services like TB tests.
In this case, since the patient has not been seen in the clinic for over 3 years, but had a TB test ordered through the clinic last year, the patient can still be considered a new patient for billing purposes, as the TB test order does not constitute a face-to-face encounter. Therefore, you can bill for a new patient E&M code when the patient is seen, using the appropriate code based on the complexity of the visit and documenting thoroughly to support the level of service provided.