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mydelgado67

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gotha, FL
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Provider seen patient over 3 years ago, however PT saw patient within 3 years. Can provider bill new patient status? Thanks in advance.
 
If it is under the same Tax ID then you will bill established. We have this happen alot since we are apart of a large group. The denial will come back stating the qualification for New Patient have not been met. (Remark code B16)
 
CPT® defines a new patient as: “A new patient is one who has not received any face to face professional service from
  • the physician or qualified healthcare professional
  • of the exact same specialty or subspecialty
  • who belongs to the same group practice within the past three years

If the Provider and the PT are not of the same specialty or subspecialty then you could justify a new patient. There is also an article under the knowledge center that maybe helpful, "How Coding Guidelines Define New Patient"
 
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