Wiki E&M new pt. vs established

[RAjones]

We have a mental health group which includes ARNP-PSYCHs under the same tax ID same building

If a Licensed Mental Health Counselor performs an assessment on a behavioral health NEW patient and then they are sent to the ARNP-Psych provider for the E&M medication part the next day/week should the ARNP-Psych use a new visit code such as 99204? No psychotherapy is done only the E&M is performed by the ARNP-PSYCH.

The CPT book states "same specialty or sub-specialty under the same group seen within the last 3 years."

I am not sure if this is same specialty or sub-specialty.

We also have a medical group under the same tax ID. If the medical provider sends them to our mental health group to be seen is this a new patient for the mental health group provider? Remember this is the same clinic/tax ID.

Thank you for any help on this issue!

 

[CBaer]

E&M New pt vs est pt

To determine if they are considered to be the same specialty, you will need to check the taxonomy of the specialty, then the providers must be credentialed with that particular payer with the different taxonomy.

Psychotherapist and psychologist do have different taxonomies. You will need to check with the person that does your credentialing. I would bet they are credentialed with different taxonomies, therefore considered separate specialties.