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New versus new for 2012????

  1. #1
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    Exclamation New versus new for 2012????
    Medical Coding Books
    Have you read the definition of a new patient beginning 2012?

    "Solely for the purposes of distinguishing between new and estab. patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT codes(s). A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years"

    So....does that mean, for example, if my hand surgeon treats a patient for the first time and he has previously been treated by our other ortho MD, he's no longer new?

    What's your interp????

  2. #2
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    Yes that is how I take it. It was 2 years ago that I read that this was on the plan to implement. But your interpretation is how I understood it then and it does not appear that they have changed their intent.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Geezzzz....Debra, I hope you're not right (which I think you are). We are going to receive opposition on this!

  4. #4
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    Oh heck yeah! Where did you see this was being implemented for 2012, I had not noticed an implementation date, I just knew they were planning it.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    I read it in my 2012 CPT book.

  6. #6
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    Ah I do not have mine yet. I ordered it in July and still do not have it, I hate that we have to wait for the book to know what the changes are. I need that information now!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    I think I'm making this harder than it really is or else I'm having a moment...

    Looking at the decision tree in CPT 2012, it askes is it exact same specialty?....yes (my answer)....is it the exact same subspecialty?.....No (again my answer). The decision tree states "new patient". So...if ortho A treats patient and 6 months later ortho B (hand surgeon) treats patient, this should still be new...(??) Your take Deb? I'm really hearing alot of "buzz" supporting the opposite but I don't want to react to "hearsay" just yet....

  8. #8
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    Quote Originally Posted by RebeccaWoodward* View Post
    I think I'm making this harder than it really is or else I'm having a moment...

    Looking at the decision tree in CPT 2012, it askes is it exact same specialty?....yes (my answer)....is it the exact same subspecialty?.....No (again my answer). The decision tree states "new patient". So...if ortho A treats patient and 6 months later ortho B (hand surgeon) treats patient, this should still be new...(??) Your take Deb? I'm really hearing alot of "buzz" supporting the opposite but I don't want to react to "hearsay" just yet....
    From the description here, my take would be that if the patient saw two different "hand" specialists, it would be established. But if they saw a "hand" specialist and then a "leg" specialist, that would be a different subspecialty. Ortho specialists, but two different subspecialties....just thinking...guess we will see.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  9. #9
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    This is good news, right? Before...if they were in the same practice and of the same specialty (ortho) they had to be established. Now that the decision tree has grown another branch....we're able to bill a new patient for a different sub specialist in the same practice setting.

    ajs---that's how I interpreted it as well.

    Deb, I can scan those pages of CPT to your email if you'd like (send me a PM).
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  10. #10
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    Pam,

    I sent you a PM, but will you send me the pages as well? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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