From what I remember reading (I'll try to find the documentation), subspecialties are not recognized when differentiating between new and established patients.
However, in the example you gave, the 2 subs you mentioned are Phys Med & Rehab, and a Hand Spec. Is PM&R really considered Ortho? We have PM&R here in my clinic, but our other specialties are Neurology and Neurosurgery...therefore no other Ortho to get in the way. I was under the impression that PM&R is it's own specialty, not a sub of Ortho...I could be wrong about that. If PM&R is it's own specialty, then when the patient seen the Hand Spec a year later, then the pt should be considered new. But if they see a knee ortho, then a year later the hand ortho, they would be establ...does that make sense?
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