Wiki New Pt visits different specialty/same npi tax

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nouwinga

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Hello. I have a question re: billing new patient visits for two different specialties under one NPI/Tax id. Will insurances pay for this? They would normally be on different days. I appreciate any information you can offer. All I can find is if the visits were performed the same day but that is not our case.
 
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I code for multiple specialties under the same TAX ID and found that it depends on the payer, for Medicare we have had success receiving payment for billing two different new patient visits on the same date of service with different specialties with modifier 25 (for professional) and modifier 27 (for technical if you bill both parts) Other payers like Blue Shield of California and Blue Cross of California will pay on both claims however will do a recoupment like 5 months later stating the patient is not a new patient, but an established patient due to being seen with the same Tax ID within the last three years. But we have not had any issues billing this for government payers.
 
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This post is not the exact same question however, has links and info on deciding new vs. established.

It depends on the what payer you are billing the claim to and whether they recognize different subspecialties and/or follow CMS or CPT or make their own rules up. It also depends on how the provider is credentialed. Some payers don't look at this and they only see the group Tax ID or NPI and would not allow another new patient E/M if another provider in the group has already billed a new within 3 years.

You have to look up the payer rules for who you are billing to. Most of the time the policy is called new patient or Evaluation and Management or something of that sort.
Example: https://www.uhcprovider.com/content...omm-reimbursement/COMM-New-Patient-Policy.pdf

Here are some other discussions from the forums on it. Keep in mind some may be older and talking 95/97 E/M if there are any discussions about the code levels.

You can always search the forums for key words such as new patient, established patient, etc. This question is asked over and over in here.
 
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