Dermatology Coding Alert

Published on Mon Mar 08, 2004 PDF

Question: Our practice includes eight dermatologists. Often, a new patient will see one doctor and then another doctor, based on availability or specialty in procedure. If the patient sees a different doctor in our practice, is she considered a new patient or an established patient?

New York Subscriber

Answer: The definition of a new patient is a patient who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.

When a physician is on-call for another physician, you classify the patient's encounter as a regular visit, just as the patient's regular physician would classify the visit. 

If it is a matter of convenience for your practice, there should be no penalty to the patient just because the covering physician has never seen the patient before.

However, Medicare recognizes "subspecialties" within a specialty. For example, if you a have a dermatologist within the group who is also a pathologist and specializes in Mohs procedures, the Mohs specialist can report a consultation if all the requirements for a consultation have been met.