Primary Care Coding Alert

 Question: Recently, we added two new physicians to our practice. Should we code all encounters as new-patient visits when these doctors see an individual for the first time?

New Jersey Subscriber       
Answer: No. The new-patient codes describe the fact that the patient is new, not the physician. New-patient codes (99201-99205, office or other outpatient visit, new patient, and 99381-99387, initial preventive visit, new patient) are assigned when patients have not received any professional services from an individual physician or from  another physician of the same specialty who belongs to the same group practice within the previous three years.
     
Therefore, if these new physicians practice within the same specialty as the veteran members of the group, patient encounters would be coded with established-patient codes, 99211-99215 or 99391-99397. However, if they represent a different specialty (e.g., internal medicine, pediatrics, gynecology), then the new-patient codes would rightfully be assigned.