Results 1 to 3 of 3

E/M coding help!

  1. #1
    Location
    South Denver
    Posts
    19
    Default E/M coding help!
    Exam Training Packages
    We are a spine facility in which we have 2 surgeons and 2 PM&R providers. If a patient is seen by the surgeon for DDD but is referred to PM&R to address pain - does PM&R provider charge as established or new patient since he is a different speciality? Please advise because our coders think this is an established patient because he/she is seen in the same facility regardless of specialty - PM&R physicians are challenging us - stating they would be new patient. Please someone help and reply!!!

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    In my experience with our practices, if a pt is seen in Int med then transfers to Family practice then the pt is new. If they transfer from family practice to family practice then they are considered established. We all share the same tax id. Hope this helps.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Show them this....

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years.

    I have orthopaedic/neuro surgeons, also. If my orthopaedic surgeon refers the patient to Pain Mgmt, this is a New patient (assuming the patient has never seen anyone at Pain). They are different specialties.

    30.6.7

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Also...
    By CPT definition, a new patient is "one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years."

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

    This logic is the fundementals of coding.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.