Wiki Multiple Specialties in Large Group - New visit

[Summer]

Can you help clarify the new patient rules related to multiple specialties in the same group practice? If we have different specialties (e.g., Pain Management, Podiatry, Rheumatology, Orthopaedics) can we charge a New Visit code when the patient is seen for the first time by a physician in a different specialty in the practice? If so, will you provider any type of official guidelines to support.

Thank you!

 

[csperoni]

Review the AMA guidelines:
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. A new patient is one who
has not received any professional services from the physician or other qualified health care
professional or another physician or other qualified health care professional of the exact same
specialty and subspecialty who belongs to the same group practice, within the past three years.
An established patient is one who has received professional services from the physician or other
qualified health care professional or another physician or other qualified health care professional
of the exact same specialty and subspecialty who belongs to the same group practice, within the
past three years. See Decision Tree for New vs Established Patients.

Keep in mind some of this is determined how your providers are credentialed with the carrier.