ksarith9@gmail.com
Networker
E&M, A general practitioner sees the patient for 4 visits, and later he upgrades to a specialist. Is the next visit of the same patient New or Est?
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Wiki E&M ,A general practitioner sees the patient for 4 visits, and later he upgrades to a specialist. Is the next visit of the same patient New or Est?
- Thread starter ksarith9@gmail.com
- Start date
CBLENNIE
Expert
What is the specialty of the "specialist" the patient is upgrading to? If they are of a different specialty and subspecialty then it potentially could be a new patient visit with the specialist.
I'm finding the wording of your question a little vague.
If the patient is seeing the same physician for visit #5, it is established. This is regardless of the specialty/subspecialty or group.
If the patient is seeing a different physician of the same specialty/subspecialty in the same group practice, it is established.
If the patient is seeing a physician of a DIFFERENT specialty/subspecialty in the same group practice, it is new.
If the patient is seeing a physician of a different group practice (regardless of specialty), it is new.
Keep in mind that Medicare uses only their 2 digit specialty codes to distinguish specialties, but commercial insurances will typically distinguish by taxonomy codes which has many more options for specialty.
If the patient is seeing the same physician for visit #5, it is established. This is regardless of the specialty/subspecialty or group.
If the patient is seeing a different physician of the same specialty/subspecialty in the same group practice, it is established.
If the patient is seeing a physician of a DIFFERENT specialty/subspecialty in the same group practice, it is new.
If the patient is seeing a physician of a different group practice (regardless of specialty), it is new.
Keep in mind that Medicare uses only their 2 digit specialty codes to distinguish specialties, but commercial insurances will typically distinguish by taxonomy codes which has many more options for specialty.