Wiki E/M initial visit

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Are you asking about 'initial' visits for hospital E/M services, or 'new patient' visits in the office? These are two different things and are handled differently. Take a look at the CPT guidelines for both of these.

You have to consider both 'group' AND 'specialty' for new patient coding. Group is almost always determined by tax ID. Specialty is handled differently by different payers depending on how they do their credentialing and enrollment, but usually goes by the primary specialty category (e.g. internal medicine, dermatology, cardiology, etc.) and not by the more specific taxonomy code.
 
Thank you for your response Thomas. CPT guidelines are unclear for me as I am questioning whether an established patient that has been seen at our palliative care practice enrolls in our hospice. Would it be considered an initial visit once they are a hospice patient?
 
rtriha said:
Thank you for your response Thomas. CPT guidelines are unclear for me as I am questioning whether an established patient that has been seen at our palliative care practice enrolls in our hospice. Would it be considered an initial visit once they are a hospice patient?
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Codes that have 'new' or 'established' in the descriptors are assigned based on whether or not the patient has been seen by a provider in the same practice and same specialty withing the last three years. Codes that have 'initial' or 'subsequent' in the descriptors are assigned based on whether or not this is the first visit by the provider (or a provider of the same specialty in your group) during that patient's stay in the facility. So only one 'initial' visit is allowed per admission for any given provider and specialty. But if the patient is discharged and admitted again, then you would bill another initial code for the first visit during the new stay. The coding for initial and subsequent visits is not affected at all by whether the patient is new or established. Hope that helps make it a bit clearer.
 
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