Wiki Established vs New Patient Question


Cedar Rapids, IA
Best answers
This is my first time posting :D

I work for a hosptial who has outlying clinics. We have an NP who sees dermatology patients here at my clinic.

There is a patient who is seen by another physican who is affilated with the same hospital and clinics as my NP. This patient was seen for her derm concerns only at my clinic.

This is a medicare patient and my NP charged her out as a new patient, since she has never seen this patient before.

It is my understanding, that since she was seen for her derm concern only, it would be appropiate for her to charge a new ov. According to the tree in the CPT book, she would be new

My Centeral Billing office is telling me my NP can't charge a new ov because another physican in our clinic/hosptial system saw her.

:eek: I'm confused.
If the patient has not seen another NP within your group/practice then you can bill a new patient visit. New vs Established is based on specialties within a group/practice setting. Because NPs are not bound to one specific specialty the New vs Established rule is based on if the patient has seen another NP or not.