Wiki cardiology subspecialits & consults

[dmd1019]

Our EP specialists want to bill an established patient as a new patient because they are considered subspecialists. I cannot find anything that states subspecialists do not have to follow the consultation guidelines when it come to new vs established patients. With Medicare they want to bill a 99204 with a crosswalk code of 99244.

 

[pmoshi]

If they are in the same group practice (group NPI is the same) it is to my knowledge the patient is established.

 

[espressoguy]

If you look at the E/M guidelines in your CPT manual there is a decision tree that indicates that a provider in a subspecialty may bill a new patient visit even though the patient has previously been seen by another provider within the general specialty in the previous 3 years.

Not all subspecialties are recognized by CMS as subspecialties, but EP is recognized.