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Thread: new patient or established?

  1. #1

    Default new patient or established?

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    A patient was seen within the past three years by Family Practice provider in a multi-specialty clinic(all use the same tax ID#). Same patient seen in Urgent Care and /or Internal Medicine. Is this person a new or established patient, assuming all other conditions exist for a newbie?

  2. #2
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    Quote Originally Posted by efuhrmann View Post
    A patient was seen within the past three years by Family Practice provider in a multi-specialty clinic(all use the same tax ID#). Same patient seen in Urgent Care and /or Internal Medicine. Is this person a new or established patient, assuming all other conditions exist for a newbie?
    Established.....
    Yolanda T. Haskins CPC, CRC, OHCC
    AAPCCA Board of Directors 2014 - 2017
    Region 1 - NorthEast - ME, NH, VT, MA, RI, CT, NY


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  3. #3
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    We have a similar issue here. We are a Critical Access Hospital. Because the pt is seen by a different speciality they may be coded as new. If in an urgent /emergency room situation, the internal med provider saw the pt they would be new. If they follow up in the office then I would use the correct E&M code. Good Luck.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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    Quote Originally Posted by kbarron View Post
    We have a similar issue here. We are a Critical Access Hospital. Because the pt is seen by a different speciality they may be coded as new. If in an urgent /emergency room situation, the internal med provider saw the pt they would be new. If they follow up in the office then I would use the correct E&M code. Good Luck.

    What about the same TAX ID #?
    Yolanda T. Haskins CPC, CRC, OHCC
    AAPCCA Board of Directors 2014 - 2017
    Region 1 - NorthEast - ME, NH, VT, MA, RI, CT, NY


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  5. #5
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    We are the same tax id, different specialties.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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    Quote Originally Posted by kbarron View Post
    We are the same tax id, different specialties.
    OK....
    Yolanda T. Haskins CPC, CRC, OHCC
    AAPCCA Board of Directors 2014 - 2017
    Region 1 - NorthEast - ME, NH, VT, MA, RI, CT, NY


    Yolanda.Haskins@aapcca.org

    Alexandria, VA Chapter


    ~ Practice Kindness ~

  7. #7
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    It may be a good idea to track the claim and see what happens to it.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
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    Elizabeth,

    Your scenario seems very similar to our setting. We are a physician group practice. Within our group practice, we have an Urgent Care facility. Those physicians that work in our Urgent Care Center are Family Practice/Internal Med physicians. Once that patient/doctor relationship is established in our Urgent Care setting, they are established patients when they return to see our Internal Med or Family Practice physicians. The patient likes the convenience of walking in without an appointment and decide to use our Urgent Care Center as their PCP. Many of our carriers stipulate in their contract that Family Practice/Internal Med is one in the same. My opinion...this is an established patient based on your scenario.

  9. #9

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    Are Urgent Care Centers required to pay additional fees just for operating during a 24 hour basis? I have seen some Urgent Care Centers charge a couple hundred dollars under HCPCS code S9088--which is for an urgent care center (in addition to the service code byt the physician). Why do you typically bill with this additional code and do you usually get paid for it?

  10. #10
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    Our Urgent Care Center does not function 24/7. We are open 7 days a week but not past 7 p.m. We charge a standard fee...

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