Wiki Internal Med vs Family practice

[KoBee]

We have an internal med provider is billing new patient codes for patients who have seen a family practice provider within the last 3 years, are they considered two different specialties?

I did read the following, which sound different per age
Family doctor treats patients of all ages, while an internist specializes in the care and treatment of only adults.

Both providers are falling under our Adult med dept. Should internal med provider should be billing new patient codes if meets requirements or not?

getting confused :/ help!

 

[thomas7331]

These are definitely two different specialties. On the Medicare enrollment forms, the provider would identify one or the other as their primary specialty. Other payers may follow different rules, of course, for example if both providers are fulfilling the role of a primary care physician. But there’s nothing incorrect from a coding perspective about treating these as providers of different specialties.

 

[amyjph]

Good advice from Thomas.
You have to know how the provider is credentialed and their specialty/subspecialty.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Find-Your-Taxonomy-Code

CMS information:
https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf 30.6.7 - Payment for Office or Other Outpatient Evaluation and Management (E/M) Visits (Codes 99202 - 99215)
United example: https://www.uhcprovider.com/content...omm-reimbursement/COMM-New-Patient-Policy.pdf
Like Thomas said, other payers may follow different rules. Some don't recognize specialty/subspecialty and if the group TIN has reported a new patient EM, the patient is established to all.