Wiki Billing Initial Visits - Dr. Split from Previous Practice

[Kaitlyns@goaoi.com]

Hello,

I tried doing some online research but I am getting conflicting information. The doctor that I work for just split from a practice and started his own. The split was very sudden and not friendly and the medical records from the previous practice have not transferred so we have no way of confirming the patient's appointment history. We have a new tax ID and group NPI different from our previous practice. My question is, do we bill a 99203/4 for the patients initial visit with us because it's a new practice or do I bill 99213/4 for patients that we know for a fact were seen at our previous office?

 

[catherinetinkey@entmedicalservices.org]

The group NPI doesn't make a difference, the physician's NPI is the same and if the specialty is the same the patient is a return for any patient he/she has seen in the last 3years and follows him to new practice. If the specialty is completely different they would be considered a new.

 

[csperoni]

Yes. The AMA definitions are in your CPT book:
A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty 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 other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
Notice it is "OR" between the phrases. So if the physician provided professional services in the past 3 years, even if while employed at a different group, that is an established patient.