New Patient

judicline

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We submitted a claim to Medicare for a new patient visit and it was denied. This claim was for Pain Management we also are Anesthesiologist practice under the same tax ID #. The patient was given anesthesia for a surgical procedure earlier in the month. The dx for the office visit was unrelated to the anesthesia.
When I read the new patient requirements I agree with the denial others in my office say they should of paid it.

Please advise.
 
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Malone
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Here is a good article on this
http://www.aafp.org/fpm/20030900/33unde.html



Although groups with multiple practice sites may operate independently, with each caring for its own patient population and maintaining its own medical records, they are considered a single group if they have the same tax identification number.



In a single-specialty practice, the patient's encounter should be reported with a code in a new patient category only if no physician or other provider who reports services using CPT codes in that group has seen the patient within the last three years.​
 
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