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New vs Est pt w/ent & Sleep Specialist

  1. #1
    Monroe, NC chapter
    Question New vs Est pt w/ent & Sleep Specialist
    Medical Coding Books
    In a large group practice with ENTs and Sleep Specialists... If a patient has been seen in last 3 yrs by one of our ENT providers, and then is seen by the Sleep Specialist, can the Sleep Dr bill a new pt e/m or are they still considered established? I've been told 2 diff. answers by coworkers so need this cleared up! Thanks...

  2. #2
    Tyler, Texas
    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.

  3. #3
    Monroe, NC chapter
    Hi Dr Spain,
    thanks for your reply... I was reading another post which raised more questions for me (and maybe the points raised are non-relevant??)... they brought up how if the diff. specialists were credentialled the same then one couldn't bill a new pt... So, does the credentialling make a difference or not? Here is the link to the other post:

    Any more information on this would be so welcomed!
    Last edited by bungalowgirl; 12-30-2011 at 03:15 PM.

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