• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki e/m question

Create Wiki
H

heart123

Guest
Messages
316
Location
Greenwood, SC
Best answers
0
if i have 22 doctors in my office but they all do different things if 1 refers to another can i code a new visit if they have seen another doctor in my office with a different specialty???
i say no it is not a new pt visit
someone else says yes
whats your input
please
 
This is a duplicate post - your same question was posted and answered on the Billing forum. This is also a topic that is frequently discussed on the forum so if you do a search, you'll find many responses available.

I'd refer you to the CPT book definitions of new and established patients at the beginning of the Evaluation and Management chapter: "A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." There's also a helpful decision tree in the book that walks you through the questions to ask to make the correct choice.

So in your case, if the patient is being referred from one specialty to a different specialty within your practice, and has never had a face to face encounter with that new specialist in the last three years, or another provider in your practice of that same specialty, then yes, they can be coded as a new patient.
 
even if they have the same tax id ???
i had been taught that if they are under the same tax id then he would not be a new pt but established ???
 
Yes even same TIN (group practice). Say you are established to an Ophthalmologist in the practice. Most of the past work by ophthalmology wont apply to the Cardiologist so they are new to Cardiology.
 
1 doctor is a cardiologist the other interventional
both with the same group, same tax id
they can both bill a new patient visit ???
really???
im sorry just trying to get this straight in my head

ok i just saw the cpt book wow
thanks
 
Last edited:
If they are both cardiologist then the patient would be considered established because they are the same specialty within the same group. We have a practice that has Cardiologists and Vascular Surgeons when one refers to the other they would be considered a new patient because of the different specialties. Thomas gave you great direction from our CPT manual. Another great resource when looking for guidance is your local MAC. Ours is NGS and they have E/M specific FAQ's here is a link.

https://www.ngsmedicare.com/ngs/por...p1f83tMfL1A7u58!/dl5/d5/L2dBISEvZ0FBIS9nQSEh/

Kind Regards,
Steph
 
You must log in or register to reply here.
Top