" change of practice " vs " group practice "


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Having a discussion in understanding " change of practice " vs " group practice " to correctly code providers established patients.

Our organization acquired or should say bought a pulmonary clinic, with in this clinic there is 2 providers who are now under our organization. They will continue to see their current or new patients in that clinic but since now under our organization, would the providers established patients considered NEW to us, or continue to be established and bill follow up visits as 99211-13?

Can someone help so we bill this correctly for follow up patients.


True Blue
Beaverton OR
Best answers
Classic New vs. Established scenario and a great question.

Remember that if the patient has seen a provider within three years, then the patient is considered "Established" in terms of E/M coding, and we follow the provider. This means that if the new Pulmonologist A (Dr. Lungs, new doc from the bought clinic) saw a patient (Mr. Jones) on 1/2/2017, and the patient was seen again by a veteran Pulmonologist B (Dr. Bronchi, who was originally with the practice) on 5/5/2019, then Mr. Jones would be considered "Established" for at least his second visit. Because Dr. Lungs now belongs to your organization, all of his/her patients who are seen by another pulmonologist (like Dr. Bronchi) within that 3 year threshold, will be considered "Established".

Here is some good information on New vs. Established from my local MAC:

Noridian - New vs. Established

Hope that helps!