HELP - -MDM Points - pt seeing different providers at same practice

dappy

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We have multiple providers at different locations that all go under the same TAX ID and NPI. If a pt goes to see one provider for a condition then goes to another location seeing a different provider for the same condition - would you count this condition as a NEW problem for the second provider or an establish problem. Thanks
 

jdibble

True Blue
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We have multiple providers at different locations that all go under the same TAX ID and NPI. If a pt goes to see one provider for a condition then goes to another location seeing a different provider for the same condition - would you count this condition as a NEW problem for the second provider or an establish problem. Thanks
For MDM points, I would count this as a new problem for the second provider. I would suggest that this provider document that this is the first time they are seeing this patient for this problem. The description in the box under A says "new problem (to examiner)" and we were instructed by our Medicare carrier that this would be considered a new problem if the provider never saw the patient for this issue - regardless of it being the same provider group.
 
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Coastal Coders
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The carriers I audit instruct that all providers in the same group are to be treated as a single entity. As such an established problem is an established problem no matter if Dr A, B or C is seeing them.
 
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cpc, cgic

I agree that if provider A sees patient and a week later patient sees provider B within that group it is a new problem to provider B and provider B should document that it is a new problem.

Thanks
Anne
 
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