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Thread: New vs. Established Patients

  1. #1
    Join Date
    Apr 2007
    Posts
    24

    Default New vs. Established Patients

    Promo: Code Books
    Billing for new patients services for office visits are as follows: A new patient is defined as someone who has never been seen by you or a physician in the same specialty in your group OR who has not been seen by you or a physician in the same specialty in your group for at least three years.

    Question:
    How would you bill for services if the provider is listed under the same specialty i.e. an Ophthalmologist, but treats an established patient under his/her subspecialty. Would this be billed as an established patient or can it be billed as a new patient under the subspecialty? ( The providers are using the same TIN number).

    Please advise

    Thanks,

  2. #2
    Join Date
    Apr 2007
    Location
    Kingsport, TN
    Posts
    149

    Default New or Established

    If you look at the Decision Tree for New vs Established Patients in CPT and follow the questions/answers it appears in your situation, NEW patient would be your answer.

  3. #3
    Join Date
    Apr 2007
    Posts
    1,716

    Default

    I'm not sure I understand.

    The patient is established with the provider under one specialty but he is seeing them under a different subspecialty now?

    If it is the same provider it doesn't matter what specialty they are, if that individual has seen the patient within the last 3 years they are established with that provider.

    Now, if they are established with the group under one specialty but are being seen by a different recognized specialty yes the patient would be new. But many subspecialties are not recognized and are treated the same as if they weren't subspecialized.

    Common example is Cardiology and EP. EP is not recognized and is just considered Cardiology.

    Laura, CPC, CPMA, CEMC

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