Wiki New patient codes--same dr, different practice

[gnatipus]

One of our doctors came to us from a nearby practice. Many of his existing patients followed him. We billed those patients' first visits to our practice as new patient visits, since they were new to our practice. But they weren't new to the doctor. Some of the payments already made are being recouped because 'new patient qualifications were not met.' It seems to me that claims under a completely different practice tax ID should qualify as a new patient, even if the doctor is the same. Am I wrong? Is there a coding rule I'm missing that would address this issue?
'

 

[AmandaBriggs]

There is a decision tree in the CPT book prefacing the E/M section. The first question it asks is, "Received any professional service from the physician/qualified health care professional or another physician/qualified health care professional in same group of same specialty within past three years." Basically, it doesn't matter where the physician sees his patients or if the tax ID has changed, if the provider has seen the patient within the last 3 years they are established to that provider. Hope this helps.

 

[cgaston]

The MD has only changed where he/she sees the patient; they are not rendering services to someone they have not seen within the past 3 years. That is why it would not qualify as a new patient.