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New vs established patient

  1. #1
    Default New vs established patient
    Medical Coding Books
    Hi,

    I have never considered a family practice and internal medicine to be two different specialities in our office when it comes to new patient vs estab patient. They share the same EMR and are treating the same problems. The family medicine physician is wanting me to charge a new patient visit even though the internal medicine physician across the hallway had seen her very recently. I'm confused, I know that I haven't done it that way in the past but maybe it was wrong not to.???

    Any suggestions would be helpful.
    Thanks,
    Becky

  2. #2
    Default
    Quote Originally Posted by bwerner View Post
    Hi,

    I have never considered a family practice and internal medicine to be two different specialities in our office when it comes to new patient vs estab patient. They share the same EMR and are treating the same problems. The family medicine physician is wanting me to charge a new patient visit even though the internal medicine physician across the hallway had seen her very recently. I'm confused, I know that I haven't done it that way in the past but maybe it was wrong not to.???

    Any suggestions would be helpful.
    Thanks,
    Becky
    Are the physicians sharing the same tax id# and are they treating the patient for the same issue/problem?
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. #3
    Default
    Technically, they are different specialties, so you can bill a new patient code. Family practice is 08, and IM is 11. In order for a patient to be considered established, they have to have been seen by another provider of the same specialty, in the same group (ie, same tax ID), within the past 3 years. We run into this quite a bit in our office. Hope that helps!

  4. #4
    Default
    Hi,

    To Roxanne, yes same tax ID# and same issues. We have been recently taken over by our hospital and I know that in the private clinic setting, we didn't charge a new patient in this situation because of PR reasons. I may have to ask my new supervisor how they want to handle this situation. I think it should be an established patient just because she has been to the clinic for a long time, just switched to a different doctor within which happens all the time but I'm sure she is unaware that she will be charged a significant amount higher.

    Thanks for the suggestions.
    Becky

  5. #5
    Default
    Becky - most commercial insurers won't re-code a claim to "New" if it was billed as established, because established codes usually have a lower allowed amount. (They're real quick to change it the other way around, though...). Cigna and UHC are the most diligent on the new/established code assignments. Either way, the new patient upcharge isn't big enough to make a huge difference, if the patient has a deductible to satisfy. I wouldn't sweat it.

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