Wiki New patient?

[Mwinders]

Many years ago when working for a multi-specialty group, I was instructed that only the first provider seeing a patient could bill for a new patient. After that, it should be an established patient no matter who saw the patient.

In reading the current E&M Guidelines, it states, "A new patient is one who has not received any 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.

I've added a psychiatrist to our family practice group-is it appropriate to bill for a new patient visit when the psychiatrist sees the patient when referred by the family physician?

In both circumstances, the group shares a TIN.

Thank you!

 

[AmandaBriggs]

I would say that yes, the patient would be new to the psychiatrist and would be appropriate to bill a new patient visit. The specialties are different, family practice and psychiatry so even thought they are within the same group, the psychiatrist should have a different taxonomy classification.

 

[teresabug]

be prepared to have to appeal claims, but yes a different specialty requires a different taxonomy code and the patient would be new to the specialist. Alot of the MCR advantage plans like to deny these types of claims in error.