New Physician with a new specialty in a family pratice

mlowery31

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We are a family practice clinic with a DO and FNP. We recently had an internist join our practice. When she sees patients who are already established with the practice but will be seeing her as their new PCP can we bill that visit as a new patient visit since she has a different specialty? Or is primary care - primary care?
 
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We are a family practice clinic with a DO and FNP. We recently had an internist join our practice. When she sees patients who are already established with the practice but will be seeing her as their new PCP can we bill that visit as a new patient visit since she has a different specialty? Or is primary care - primary care?

If the patient has already been seen under the group's TIN, they are an established patient, even if the provider is new to the practice. That's where the specialty portion comes in. CPT states if the provider is of the same specialty and same subspecialty, they are an established patient. Medicare does not follow the subspecialty portion, just the same specialty. I know other payers follow Medicare but I couldn't tell you who they might be. The Healthcare Provider Taxonomy Code would distinguish the specialty.

https://www.cms.gov/medicare/provid...ation/medicareprovidersupenroll/taxonomy.html
https://www.cms.gov/Medicare/Provid...iderSupEnroll/Downloads/TaxonomyCrosswalk.pdf

You can check here to find out a provider's Taxonomy Code:
https://npiregistry.cms.hhs.gov/
 
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