If the provider is a different specialty or sub specialty that any other provider in the practice that the patient has seen, it would be a new patient visit to that specialist. For example, if a patient sees a general orthopedist in the practice, and is later seen by either an othopedic hand specialist, or a pain management specialist, or an occupational medicine specialist in the same practice, the inital visit with any of these would be a new patient visit. There is a "Decision Tree" graphic in the AMA CPT book (Under the E/M Services Guidelines) that clearly shows how this is determined.
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