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Thread: New versus Established in Sub-Specialty

  1. #1

    Default New versus Established in Sub-Specialty

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    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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.

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