Wiki MFM New patient

[lorilu]

Hi MFM specialty billers

I am new to the specialty and would like to know if a Dr has seen a patient within the 3 year period and is now seeing them again for (2nd pregnancy) can the provider still bill as a new patient? He states new pregnancy new fetus?

 

[csperoni]

You could consider it a new problem, but it is still an established patient.
An established patient is one who has received 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.
This is the same rule across all specialties.

 

[lorilu]

I do know this rule but I have 2 providers challenging this as new fetus new pregnancy and new problem.

 

[lorilu]

Do you know of any publications I can refer to?

 

[csperoni]

It's in the AMA CPT book, as well as the Medicare claims processing manual, section 30.6.7 A.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
And again, a new problem does NOT EQUAL a new patient.

 

[lorilu]

Thank you : )

 

[SharonCollachi]

The fetus is not the patient.

New fetus, new pregnancy, new problem, ESTABLISHED patient (the mother).