Wiki E/M

[msjudy71655]

If a patient is currently seeing Dr.1 but sees another physician from another clinic, does the second physician charge for a new patient 99203 (for example)?

I know the 99203 category is for patients who have not been seen for 3 years.

Can Dr. 2 qualify for new patient E/M since the patient is new to their clinic?

Judy

 

[Mikiu2000]

Page 4 and 5 in the 2014 AMA CPT states: solely for the purpose of distinguishing between new and established patients, professional services are those face to face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code. A new patient is one who has not received any professional services from the physician / qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within three years.
For example a patient goes to see his primary care for ear pain and dizziness and while there the patient discusses the options for his ongoing chronic joint pain. The primary care doctor exams the patient for the ear pain with dizziness and refers the patient to an otologist. During the visit the doctor also refers the patient to a Rheumatologist for the chronic joint pain. To conserve time the patient makes both appointments on the same day. This will be the first time this patient is seeing these doctors. The guidelines state that a new patient visit is determined by face to face contact with physician or same specialty within same group, if a patient sees another physician outside of that group or sees a physician of a different subspecialty within the group this would be a new patient visit.

 

[Ggs9006]

If Dr. 1 and Dr. 2 belong to the same group, the patient would be considered an established patient and the Re-visit codes can be utilize.