Hello, I have been going back and forth on this one question a provider asked. I hope someone can help. If a provider does an Interprofessional consult on a patient and 4 months down the road, the patient schedules an apt. to see that specialist, is that patient considered a new or established patient? I have read the new patient description from CMS and CPT. Ironically their description although similar are slightly different.
IPC's are not considered an evaluation and management service but an assessment and management services which are located under the E/M section of the book. My gut says absolutely no they cant be new, however there is just something telling me I need validation. I cant find anything anywhere on Namas, CMS, My local carrier...google, lol
Thanks for the help!
Medicare definition
“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.
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. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.”
CPT® definition
“Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT® code(s). A new patient is one who has not received any professional services from the physician or another physician of the exactly same specialty and subspecialty who belongs to the same group practice within the past three years.”
IPC's are not considered an evaluation and management service but an assessment and management services which are located under the E/M section of the book. My gut says absolutely no they cant be new, however there is just something telling me I need validation. I cant find anything anywhere on Namas, CMS, My local carrier...google, lol
Thanks for the help!