Wiki Group NPI - Transfer of Care - Billing Code

[certick]

Hello!

Our location is a group of 5 providers all under the same group NPI.
A provider left and now all other providers will be continuing these patients care.
Can we bill as a new patient appointment (99245, etc) or because under the same gorup NPI is it only regular office visit codes (99215, etc)?

A provider of the practice is saying yes we can bill as 'new patients' because the one provider that left was an internist specialty where the rest are not. - Does this make a difference?

Thanks so much!

 

[cgaston]

I found this answer at karenzupko.com:

Yes, the CPT rules and Medicare rules both allow the new patient visit rules in your scenario, which is very common in large multi-specialty groups or academic centers where all specialties bill under the same tax ID. The following is a direct citation from the 2015 AMA CPT Manual: “Solely for the purposes 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(s). 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.”