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suzannereed

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If an orthopedic surgeon and a pediatric ortho surgeon are in the same office along with a podiatrist, neurosurgeon, pain management doctor, and sports medicine doctor, wouldn't the ortho surgeon and the pediatric ortho surgeon be considered the same specialty, or does the one surgeon being a "pediatric" ortho surgeon make it such that if they both see the same patient that both doctors can charge new patient visit charges? I feel they are in the same specialty. All these doctors share the same chart, yet their office manager insists that they are all different specialties and if they each see the same patient, that they can all charge new patient visits the first time each of them sees the patient. Is this right, doesn't see right to me? Any thoughts would be appreciated.:confused:
 
This is a tricky situation. I work for a multi-specialty clinic. It will depend on how your physicians are credentialed. If they are both credentialed as orthopaedic then they would be considered same specialty and the patient would be an established patient. An established patient is a patient who has seen a physician or a physician of the same specialty in a group.
 
I also agree that there is no subspecialty, two specialists under the same tax id number cannot both bill for new patients if the patient has had a face to face visit in the last 3 years.
 
I don't have my 2011 book at hand, but on Page 5 of the 2010 AMA CPT book, the decision tree clearly addresses subspecialties. My recent personal clarifications with JMAC medical directors confirm my orthopedic example, so I stand by that. If anyone has a different published directive from CMS or one of the JMAC's, I would be interested in seeing it. If there is a different credentialling exam or process for two subspecialists, then they would be considered different.
 
The subspecialist issue was further clarified in the 2012 CPT. See the article in the current Coding Edge, page 16, by Greg Verhosek, on this topic.
 
Another Source

According to AMA's principle of CPT Coding, a physician with a "separate tax ID for their subspecialty different from the general group tax ID" can bill the new patient codes, even if part of the group.
So I guess it depends on the taxonomy codes.

Lin
 
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