FM -MD and Psych-MD saw the patient only one New code should be used, right?

[mariaher921]

I have a regular family MD see a patient and then i have another MD-but does psych visits see a patient in our practice. The family MD saw patient a while back, then Psych MD saw patient.. wouldn't the psych MD see the patient as Established? We bill the Psych MD visits as E/M codes just like the Family MD.

 

[MrLittlefoot]

Probably not

"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."

That is the rule direct from the E/M section of the CPT book. So if the psych MD has the exact same specialty and subspecialty, you're right, you can't bill as a new patient. However, if they are credentialed in different specialties(family practice vs psychology) or even subspecialties, you're allowed to bill a new patient visit with the new doctor, assuming (s)he hasn't billed the patient for a face to face service within the last 3 years.

 

[mariaher921]

cont...

11/13/18 - Doctor B - MD


11/18/18 Doctor A - MD
ABPN Certified in Psychiatry & C-L Psychiatry


Those are the two providers who saw this patient.

So the 11/18/18 should be coded as new?

I was always taught though, in same practice, once seen as new then that was it. So this is new to me if i should of billed the 11/18 as a new patient visit.

 

[MrLittlefoot]

So if the doctor for 11/13/18 is credentialed as something other than Psychiatry & C-L Psychiatry, you are absolutely able to bill the appropriate new patient visit to any payer who follows the 97 e/m guidelines for both doctors. If you need documentation to back that up, you can find it in the E/M section of the AMA CPT books as well as EncoderPro(not sure about the exact location in other coding resources, as those are the two that I use.)