Specialty and Subspecialty

NESmith

Expert
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Plant City, FL
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Please explain what now is meant by exact same specialty "and subspecialty" in the new verbage of the New versus Establish Patient in the 2012 CPT book. We are having alot of disagreements as to how to interpret this.
Thanks
 

RILEY1959

Contributor
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Greater Pittsburgh Chapter
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I can explain by how it effects us. We are cardiologists and that is our specialty, however under cardiology some of our cardiologists have a sub specialty in Electrophysiology. A cardiologist will sometimes refer a patient to a colleague with that specialty. Both visits will get paid since one has a sub specialty. Something to remember though is that Medicare does not recognize every sub specialty. Hope this helps a little.
 

RILEY1959

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Greater Pittsburgh Chapter
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let me add one more thing for clarification. If the primary cardiologist saw the patient and then sent the patient to the EP doc and it was the first face to face with the EP doc then the visit with the EP doc would be considered a new patient and not an established patient.
 

AB87

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Jacksonville, FL
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If they Bill under the same Tax ID then it would be Est Patient. I started a job and wasnt there for a week and had this same issue!! They Argued me down and said "they are different Specialties". They tried to get me to Bill 2 Consults on the same Day same Patient (99253).
 

sullivak

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CMS has a listing of provider specialties (and subspecialties), and I don't know whether LCDs could have different listings of the specialties. To be on the safe side, I would go by this to determine whether a patient seeing a specialist in the same practice is seeing someone of another specialty per guidelines.

For instance, for Medicare, I don't believe that seeing a cardiologist who specializes in electrophysiology (Smitty's example) would count as a separate subspecialty. I could not find this as a Cardiology subspecialty on the CMS list.

Hope this helps!
 
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