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Thread: Same group different speciality new or established?

  1. #1

    Question Same group different speciality new or established?

    AAPC: Back to School
    Does anyone know if you can still bill a new patient office level if the patient was seen by two different doctors in the same group but of a different speciality? The patient sees Dr. A for his intial visit and Dr. A sends him to Dr. B for a consult for surgery. The doctors share the same office and they also share the same patient record. Can Dr. B also bill for a new patient office level?

    For example - a patient A comes in for an initial visit for Dr. D. Patient A fills out Dr. D's paperwork and receives the appropriate services = level 4 visit. At that visit, Dr. D recommends evaluation by Dr. C for a surgical issue. Patient A sees Dr. C for an initial visit (to him) (and is a second visit to the same office) and fills out Dr. C's paperwork was shared, can both doctors still bill a level 4 visit given the appropriate phyiscal exam? Would they have to dictate the up to date history was reviewed???? Additially - how often will they need to update this historical information?

    Since Medicare has did away with the consult codes we can no longer use those.

    Any help would be greatly appreciated.

    Thank you.


  2. #2
    Join Date
    Apr 2007


    Here is CMS's definition of "new patient" from the Medicare Carrier's Manual:

    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.
    Jenny Berkshire, CPC, CEMC, CGIC

  3. #3


    Are they able to share the same record and still bill as a new patient?

  4. #4
    Join Date
    Apr 2007


    Every encounter stands alone. The providers may share a "chart" or a record, but each encounter must be documented by the provider of the service. So if provider A, enrolled in Medicare as an Internal Medicine specialist sees the patient today and documents the service in the common medical record and refers the patient to provider B in the same practice, enrolled in Medicare as a gastroenterologist who sees the patient next week and documents the service in the same common record, Doctor B (the gastroenterologist) may bill as a new patient if s/he has not seen the patient in the past 3 years. The 3-year rule applies to only the providers in the group enrolled as gastroenterologists.
    Jenny Berkshire, CPC, CEMC, CGIC

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