Wiki Urgent Care vs Adult Med

[KoBee]

Trying to understand if a patient is seen at Urgent Care for the first time and then a week later follows up with adult med with their PCP for the first time, would each visit be considered a NEW patient CPT code?

Is urgent care and adult med considered different specialties?

 

[csperoni]

New Patient: Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.

Established Patient: Individual who has received any professional services, E/M service or other face-to-face service (e.g., surgical procedure) from this provider or another provider (same specialty or subspecialty) in the same group practice within the previous three years.

This leaves me with 2 questions:
1) Is the Urgent Care center and the PCP office part of the same group practice? If yes, then:
2) How are each of the providers credentialed with the payor? Urgent care is not a provider specialty. Neither is adult med. If both providers are internal medicine, they are the same specialty. If one is a hospitalist and the other internal med, they are different specialties. One is emergency med, the other family practice, they are different. Most private carriers differentiate by taxonomy code, which has a lot of options and subspecialties. CMS however, uses a 2 digit code and does not have nearly as many subspecialties. https://medicare.fcso.com/pe_resources/138372.asp

Note: NPPs (PA, NP, CNM, CNS) are considered to be working in the specialty of their supervising physician when applicable.

 

[cheeta3006]

Hello, can I bill a Telehealth/ Video-Audio with PCP if the patient was seen in the ER previously on the same dayby another provider for the same problem?