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New VS Established Question

  1. Default New VS Established Question
    Exam Training Packages
    The company I work for has about 5 different offices that we bill for. They are all under the same Tax ID. One of our patients was seen by our Family Practioner and then was seen by our Podiatrist a couple weeks later. We billed the Podiatry claim as a new patient since they are seperate specialties and they are not even in the same location. BCBS denied our claim stating it should have been an Established Patient code because the patient had been seen by our company before. Is this correct? I thought since the specialty was different and the doctor was different it wouldn't matter that the doctors were under the same umbrella.

  2. #2
    Northeast Kansas (NEKAAPC)
    You are correct that it should be considered a new patient visit since it is a different specialty. Does BCBS recognize Podiatry as a specialty? I know that may sound far-fetched, but you never know.
    Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC
    AAPC Fellow
    AAPC ICD-10-CM/PCS Training Expert

    Kindness is contagious-PASS IT ON!

  3. Default
    Thank you so much for the answer. I think I am going to tell our collector to call them back and make sure they are not talking about a visit with the Podiatrist before he became apart of our group. But I wanted to make sure I wasn't crazy before I told her to do that. Thanks again for your reassurance.

  4. Default New vs. Established
    I work in A/R follow up and we have a similar problem with medicare patients. There are many specialties using the same tax id affiliated with the same hospital. So if they see the podiatrist and one year later see the Orthopedist then the ortho is an established patient. We haven't been able to find a way arund it yet except to void charges and reentered them as established when we find out. I would love to know if there is another way as well.

    C Simpkins CPC, CCA

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