New vs Established e/m codes

msksmith

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Hello coders!

If a patient has been seen in the clinic for GYN and returns for a different program service area (STD) how this this be coded? New or Established? My thoughts it would be coded as an established visit regardless of what service area instead of the 99203 that the provider used.

All feedback welcomed! Thank you in advanced! :)
 

lhoot

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If the physician seeing the patient for the STD is in the same multispecialty practice as the GYN and is:
not a GYN, and
not considered a different subspecialty of GYN, and
has not been seen by any other physician in the same specialty or subspecialty of the STD physician in that practice in the last 3 years, the STD visit would be new.
If any of these conditions are true, then the STD visit would be established.

CPT Guidelines:
“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.”​

There is a CPT Asst that addresses this, Evaluation/Management: Office/Outpatient Services, CPT Assistant, June 2019, Volume 29, Issue 6, page 14. Below is an excerpt:
“Example: A patient not seen within the last three years by a large multi-specialty group sees an internal medicine physician who refers the patient to a cardiologist who is in the same large multi-specialty group. Both physicians may report a new patient code for their first visit.“​

Hope this was helpful,
Laura Hoot RHIT, CCS
 

msksmith

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We have both FNPs and WHNPs in Family Planning. To clarify once more…if a patient is seen in STD by a FNP and goes to Family Planning for a Initial Gyn appt, we can code 99203, however if the provider is an FNP the code is 99213 (Established, but higher than Return Gyn code of 203 b/c of E&M performed)?

Thanks!
 

lhoot

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msksmith,
Please accept my apologies for not responding in a timely fashion. I've learned that I don't have my alerts set up quite right and didn't realize you replied. In response to your question, I'm not well versed on the the nursing specialties, but I did some looking into it. If my research has lead me in the right direction, an FNP is a Family Nurse Practitioner and a WHNP is a Women's Health Nurse Practitioner. It is my understanding that an FNP is a family medicine provider and a WHNP is a gynecology/ob provider. My deduction would be that they are different specialties. However, since I make no claims to fully understanding the nurse practitioner classifications or the specific specialties that the practitioners in your example are associated with, I would welcome anyone else to chime in for any further clarification.

Laura
 
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