Podiatry/Establish vs. New

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Hello,

The FQHC that I work for just hired a Podiatrist. I was asked by another co-worker that codes, if an established patient should be coded under this provider as an established patient or as a new patient (this is the first time the patient will be seeing this provider at our facility) and the patient is a regular that comes to us for other services.

I thought that the patient would initially be coded under the Podiatrist as a "new patient" since this is there first time seeing him and not established.

Does anyone else have experience with this?

Thanks
 

CodingKing

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If they have seen another podiatrist in your facility in the last 3 years then they would be established. Since they are established to the practice, specialty and subspecialty will be the deciding factor.
 

hperry10

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FQHC's follow different rules than a private practice office

For FQHC's it depends on the insurance. If the patient has Medicare and has been seen by any provider in the practice in the last 3 years, specialist or not the patient is established. Medicare will deny those claims if coded as new. For any other insurance, the patient is new if they have not been seen by a provider in that specialty in the last 3 years in your practice.

This link is for FAQ's of Medicare PPS. It goes over/ new established

https://www.cms.gov/Medicare/Medicar...C-PPS-FAQs.pdf


Also, beware that Medicare does not pay FQHC's for stand alone procedures and you can only bill them with an E/M if it is warranted. Our podiatrist resigned in June and we choose not to replace him because we had to write off most of his charges due to the new Medicare PPS that went into effect July 2015.

Heather
 
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