Wiki New vs est

abbypine

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Hello, can someone please clarify this for me. Our EMR tech is telling us that we should be coding a new patient visit in this situation: patient sees one of our family practice doctors either MD or DO and then comes back three weeks later to follow up with one of our family practice nurse practitioners.
We are coding this as established because the NP is in the same practice working under the doctor's.
 
Per CPT E/M coding guidelines, "When advanced practice nurses and physician assistants are working with physicians they are considered as working in the exact same specialty and exact same subspecialties as the physician." Medicare does assign different specialty codes to advanced practice professionals making them appear to be a different specialty than the physicians they work with but I would want a written statement from my Medicare contractor stating the patient is new before I would bill a new patient visit.

Just my thoughts but think from the patient's perspective; most don't ask to see a nurse practitioner in lieu of their physician and they shouldn't be charged a higher level of visit because the practice uses nurse practitioners to provide follow-up visits.

I hope that is helpful.
Cindy
 
Hi. You are correct. The patient is established. It looks like you are a Family Practice group which means you're billing under the same Group Tax/NPI ID and Taxonomy. It is not appropriate to bill a new patient.
 
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