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New Or Est Pt

  1. Default New Or Est Pt
    Exam Training Packages
    A patient has been seen many times by his PCP. Now he has seen another dr with a different specialty but the same tax id #. Can we bill new pt?



  2. #2
    North Carolina
    Different specialty? Yes, new patient

    New patient-one who has not received any professional services from the physician, or another physician of the same specialty from the same group practice
    Last edited by RebeccaWoodward*; 01-14-2009 at 01:15 PM.

  3. Default new or estb. patient
    Yes, if they are being seen by a different speciality. Say a PCP has opened a clinic with an Cardiologist, both MD practice under the same tax id the pt would be a new to the cardiologist. Provided that the cardiologist did not see the pt in the hospital.

  4. #4
    Loma Linda
    Smile New vs Established
    So if a pt comes to MD office never seen that MD before and has CPE but in that visit the MD finds a problem and continues with a work up for that found problem would you then code an E&M as established also or both as New pts?? Where can I find documentation to support this?

  5. #5
    North Carolina
    This may become carrier specific. Below is one carriers view on a problem oriented and wellness visit on the same day.

    Preventive Medicine services include annual physical and well child examinations, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a pre-existing problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, UnitedHealthcare will reimburse the Preventive Medicine service plus 50% of one of the following problem-oriented E/M service codes only--99201-99205 or 99212-99215--when that code is appended with modifier 25. If the problem-oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.

  6. #6
    Chicopee, MA
    Hmmm, I work for an Anesthesia office and under the same tax ID its a to the doctor but not new to the practice.
    Tarringo T Vaughan BA, CPC
    Director of Pain Management
    Billing Services

  7. #7
    North Carolina

    Maybe I'm misunderstanding your statement.

    Single specialty (Anesthesia) -patient see's one of your partners (within 3 yrs) , it would be considered an established pt.

    Multispecialty-Patient is a patient of Internal Med (established)- Patient is referred to the Orthopedic physician for first time.Cpt code would be from the 99201-99205 range (different specialty)

  8. #8
    What about sub-specialties within a specialty? Like a Retina specialist in an Ophthalmology practice. They are both still ophthalmologists but retina is not recognized as an actual specialty like others would be.
    adrianne, cpc

  9. #9
    North Carolina
    Subspecialties encounters
    It is possible for a patient receiving professional services from a subspecialist within the same group to be considered a new patient to another physician within that group. If the subspecialist within the same group practice has a separate tax identification number for their subspecialty, different from that of the general group TIN, then the patient receiving professional services from the subspecialist may be considered a new patient. Some examples of this are an electrophysiology specialist in a cardiology group and a hand surgeon within an orthopedic group.
    ** CPT Assistant, Volume 9, Issue 6, June 1999


  10. Default
    Just as a note, oftentimes what is correct coding practice doesn't mean that our providers will get paid. We had a cardiologist and a PCP working together in a practice (they had been friends for years and decided to share office space/staff, etc.). After multiple rejections from a variety of carriers for consultations to the cardiologist, the cardiologist got his own own tax ID and his own door (yeah, having his own door with his name on it was some sort of big deal). So now they still share space (with an oddly named door in the space), office staff, etc. but the cardiologist can now get paid consultation fees when needed. This legality saved multitudes of hours tracking down denials and dealing with insurance issues.

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