Wiki E/M coding help!

[DevonaG]

We are a spine facility in which we have 2 surgeons and 2 PM&R providers. If a patient is seen by the surgeon for DDD but is referred to PM&R to address pain - does PM&R provider charge as established or new patient since he is a different speciality? Please advise because our coders think this is an established patient because he/she is seen in the same facility regardless of specialty - PM&R physicians are challenging us - stating they would be new patient. Please someone help and reply!!!

 

[kbarron]

In my experience with our practices, if a pt is seen in Int med then transfers to Family practice then the pt is new. If they transfer from family practice to family practice then they are considered established. We all share the same tax id. Hope this helps.

 

[RebeccaWoodward*]

Show them this....

Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years.

I have orthopaedic/neuro surgeons, also. If my orthopaedic surgeon refers the patient to Pain Mgmt, this is a New patient (assuming the patient has never seen anyone at Pain). They are different specialties.

30.6.7

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Also...
By CPT definition, a new patient is "one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years."

http://www.aafp.org/fpm/20030900/33unde.html

This logic is the fundementals of coding.