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New vs Established-We are a CAH

  1. #1
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default New vs Established-We are a CAH
    Medical Coding Books
    We are a CAH with different specialties. We have a pt that has left the pediatrics practice and transfered to the family practice. I am being told "if it is a like practice pt is not considered new". We are all the same tax id. This pt is NH Medicaid not Medicare. Does anyone have paperwork stating this? I believe that if you transfer from pediatrics to family you are new. I am also being told that if she was seen in the hospital that she is not new. PLEASE HELP!!!!
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default new Pt vs Established pt
    I wanted to clarify this.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Default
    The rules state that as long as the patient is seen for the first time in a different specialty, you can charge for a new patient visit, even if the same tax ID is used, i.e. patient was established with Pediatrics and now is seen for the first time in Family Practice or Internal Medicine.

    Hope this clarifies it.
    Jutta Whipkey, CPC

  4. #4
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Where can I find this is writing.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    you can find it in writing in the CPT 2009 Book(AMA) Professional Edition - page 1 describes it - and page 2 has a Decision Tree on it to help figure out if the patient is "New/Est"
    Donna, CPC, CPC-H

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    In a multispecialty practice, a patient might be considered new even if he or she has received care from several other physicians in the group and a medical record is available. The distinguishing factor here is the specialty designation of the provider. For example, take a patient who has been seen regularly by the pediatrician in your group. The patient is now 18 years old and wants to transfer care to a family physician in the same group. When she sees the family physician, she'll qualify as a new patient because the family physician is in a different specialty than her previous physician. This is the case even though the family physician might be treating her for an existing problem and referring to her established medical record.



    http://www.aafp.org/fpm/20030900/33unde.html#Box_D

  7. #7
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default Subspecialty Practice
    What is considered a subspecialty practice. This is on pg 2 of the CPT 2009.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    A subspecialty is narrow field within a specialty.
    this website has a nice example....
    http://www.abms.org/Who_We_Help/Phys...ecialties.aspx
    Donna, CPC, CPC-H

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