Results 1 to 5 of 5

New versus Established in Sub-Specialty

  1. #1
    Default New versus Established in Sub-Specialty
    Medical Coding Books
    I work for a Multi-Specialty Clinic and we have several Ortho providers who also have sub-specialties. One is a Hand Specialist, one is Physical Medicine & Rehabilitation, one is Knee and so on. Each one has a different taxonomy code that represent their specialty. OK, now for my question;if a patient is seen as a new patient with the Physical Medicine and Rehabilitation provider and a year later comes back and sees the Hand specialist would the patient be considered "new". I know this works in Cardiology when one is a cardiologist and the other one is a cardiac electrophysiologist but does this work for all specialists with a sub-specialty. Thanks for your help with this question.

  2. #2
    Baton Rouge
    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?
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  3. #3
    Hartford, CT
    From what I remember of my Ortho coding (I've been doing Cardiology for a few years), Hand is the only subspecialty that is recognized as separate. The caveat being that the Hand specialist has to be credentialed with the insurance companies (especially Medicare) as a Hand specialist, not just an Orthopedist who specializes in hands. If this criteria is met, then yes you could charge a new patient visit for the Hand Specialist.

  4. #4
    I work in an orthopaedic office. Yes, you can charge a new patient visit for the hand specialist.

  5. #5
    Would this also work for Spine? Medicare is denying a "new" patient visit because we have a Ortho whose specialty is shoulder and he sent a patient to our Spine provider. The Spine provider billed a "new patient visit" and Medicare states;This service was rendered by another provider with the same or similar specialty. Medicare only allows one "new patient visit" for a physician or physician group practice mamber of the same or similar specialty once every three years. We have not had this problem before and I was wondering if somethng has changed. Thanks as always for your help.

Similar Threads

  1. new patient versus established
    By Jlokloski in forum E/M
    Replies: 5
    Last Post: 02-05-2016, 06:29 AM
  2. New versus established
    By fgreen in forum Auditing General Discussion
    Replies: 3
    Last Post: 03-27-2013, 03:41 AM
  3. Replies: 1
    Last Post: 09-20-2010, 10:42 AM
  4. New versus established for an WC patient
    By pmartinez in forum EMR/EHR Systems
    Replies: 5
    Last Post: 06-25-2010, 01:38 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.