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Established or New

  1. #1
    Default Established or New
    Medical Coding Books
    I need some opinons on this scenario please:

    Dr. is in a group practice and has one tax ID. Then, the same Dr. now joins a specialty WCC group under a different tax ID. So, she's practicing with 2 different groups at the same time, one family medicine and one wound care. She does wound care one day a week and has her family practice the others.

    Now, she sees a patient in her family practice and this patient is then seen in wound care. Is this then an established patient or a new patient for wound care?

    We have had this discussion so many times my head is spinning. I am thinking it should be established since she has seen that physician BUT, am I wrong in my thinking? This is a different tax ID so, since the patient has never been seen in WCC does this make the patient new? So confusing.

    Any and all responses welcome, please help me talk this through.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  2. #2
    Default Established
    Doesn't matter how many tax ids there are, she still has the same NPI.

    Laura, CPC, CPMA, CEMC

  3. #3
    Thank you!
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  4. #4
    Look at the decision tree for new vs established patients in your CPT book under E/M service guidelines. If th physician saw the patient within last three years - established.

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