New Patient vs Established 3 year rule?

tholaday

New
Messages
3
Best answers
0
We have many family physicians who have been signed under our local hospital under one TAX ID#. These doctors have their own individual offices in different locations in the tristate area. We were told today that if a patient decides to stop seeing their regular family doctor and decides to go to another familiy doctor at another facility, then this patient would still be considered an established patient and not a new patient to this new doctor who has never seen the patient before, nor has any other doctor in their office.
The CPT guidelines for NEW vs ESTABLISHED patients do not state the rule is determined by the TAX ID# by which the multiple physicians from different group practices at different locations are under. Can someone please help to clarify? Do the individual group practices have to charge established patient e/m codes for patient's they have never seen?
Thanks for all your help!!
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
Messages
2,113
Location
South Berwick, ME
Best answers
0
We have a similar situation; multiple practices in more than one state, under one tax ID#. This makes them all one practice, from a business perspective, and the patients are considered established if going from one practice (of the same specialty) to another. This was verified by our attorney. The concept of TIN isn't addressed in CPT, because the single TIN excludes the concept of multiple practices.
 
Top