# New vs. Established Patient



## vasilchukt (Nov 1, 2012)

I am having some trouble coding for new vs. established patient specifically for PAs and ARNPs. 

We have this scenerio where the patient is seen for the first time in a specialty by a PA and then later for a different date of service by a provider who works in the same specialty on. 

Are PA and ARNPs considered a seperate specialty? Can they have a crendtialing like Orthopedics or Cardiology? How should the PA and the MD visit be coded?

Tatyana Vasilchuk, CPC


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## mitchellde (Nov 1, 2012)

no they are not a separate specialty so once see by the NP or PA they are established for the physician.
If the PA or NP sees the patient first then it is a new patient billed using the NP or PA NPI number, you may not bill new patients using the physician's NPI, also you cannot share a new patient as in they see both the provider and the NP/PA on the same day.  If they do see both and it is a new patient you can bill under the as a New patient under the PA or you can bill under the physician as an established.


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## vasilchukt (Nov 1, 2012)

What about for Medicare/Medicaid? Does this apply to them as well?


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## mitchellde (Nov 1, 2012)

absolutely, they wrote this policy


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## Naveen Rachagolla (Nov 2, 2012)

vasilchukt said:


> What about for Medicare/Medicaid? Does this apply to them as well?



*When advanced practice nurse and physician assistants are working with physicians they are considered as working in the exact same specialty and exact same subspecialties as the physician.*
A physician or other qualified health care professional is and individual whi is qualified by education. training, licensure/regulation (when applicable), and facility privileging ( when applicable) who performs aprofessiobal service within his or her scope of practice and independently reports that professional services.

These professionals are distinct from  *Clinical Staff*. *A clinical staff member is a person who works under the supersion of a physician or law, regulation and facility policy to perform or assist in the performance of a specific professional service, but does not individually report that professional service. *Other policies may also affect who may report specific services.

This is from cpt 2013 professional, page # 5 lefttop.


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