Frequency of E/M

tcraig

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Can someone please help me???? I always understood that you could not charge a new patient E/M code if the patient has been seen by someone in the practise within the last 3 years. I was told this morning that is not correct. I was told, that if the practitioner is of a different specialty, but still in the group, he could charge a new patient E/M within that 3
years. Could someone please clarify?
 

jmcpolin

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It used to be that a different specialist within the group could bill another consultation but never as a new patient visit.
 

RebeccaWoodward*

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Can someone please help me???? I always understood that you could not charge a new patient E/M code if the patient has been seen by someone in the practise within the last 3 years. I was told this morning that is not correct. I was told, that if the practitioner is of a different specialty, but still in the group, he could charge a new patient E/M within that 3
years. Could someone please clarify?
A Definition of New Patient for Selection of E/M Visit Code

"Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years."


So...if your patient is treated by internal medicine and then see's your (i.e.) ortho MD for the 1st time, w/in the last 3 years, your ortho MD can submit a new E/M

http://www.cms.gov/manuals/downloads/clm104c12.pdf

Page 51
 

jmcpolin

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I am confused it says same physician or same group practice, if there are 2 different specialists but in the same practice billing under the same Tax ID and all of that they both can't bill a new patient.
 

jmcpolin

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For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit.

It only states that if there was no face to face time by anyone in that practice they remain a new patient.
 

OCD_coder

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Subspecialties are billable within the same practice/same tax ID because they have different taxonomies. But you must have it recognized by MCR or the payor in order to bill a new pt for each taxonomy.

For example you can have a hand specialist, a sports specialist and a pain specialist all within the same group and bill with the same tax ID. But they are separate taxonomies per MCR rules. It's very similar to having separate practices within the same clinic setting.

Hope this helps.
 
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