# New vs Est with af modifier



## jturner32 (May 23, 2014)

Can a doctor in an orthopedic group who has a primary Hand Surgery specialty bill a new pt ov for a pt that has been seen by another doctor in the group with an orthopedic specialty? I have contacted Medicare and the rep said they do not recognize the AF modifier.


----------



## bethdeak (May 23, 2014)

jturner32 said:


> Can a doctor in an orthopedic group who has a primary Hand Surgery specialty bill a new pt ov for a pt that has been seen by another doctor in the group with an orthopedic specialty? I have contacted Medicare and the rep said they do not recognize the AF modifier.



It's my understanding that the AF modifier is viewed as informational for Medicare.


----------



## ehanna (May 23, 2014)

jturner32 said:


> Can a doctor in an orthopedic group who has a primary Hand Surgery specialty bill a new pt ov for a pt that has been seen by another doctor in the group with an orthopedic specialty? I have contacted Medicare and the rep said they do not recognize the AF modifier.



If the insurance company accepts consult codes he, as the hand specialist, can take referrals from other orthopods that don't specialize in hands, but if it can't be billed as a consult then it would be an existing patient as the patient is established with the practice. I hope this helps 

E


----------



## MarcusM (May 23, 2014)

HCPCS MODIFIER "AF"

Description: Specialty Physician

http://www.palmettogba.com/palmetto...es~Modifier Lookup~8EELAC6880?open&navmenu=||

Guidelines/Instructions:
This modifier is purely informational for Medicare use and may be submitted with all HCPCS and CPT codes. Because this modifier is informational only, submit this modifier in the last modifier position after any other appropriate modifiers.

I also found this:

AF modifier - Specialty Physician Provided Service
AF Modifier: Description : Specialty Physician Provided Service (for determining Physician Scarcity Area (PSA) bonus).
Required for Claims : Critical Access Hospitals (CAHs) Electing the Optional Payment Method (Method II)
Type of Bill: 85X

Coding Guidelines : Applies to services rendered by a primary care physician (e.g. general practice,
family practice, internal medicine, OB/GYN)

General Guidelines : This modifier should be used only for critical access hospitals who elect the Method 2 outpatient payment methodology (All-inclusive rate) when the professional services are performed by primary care physician in a physician scarcity area (PSA) The reimbursement is a bonus payment that is separate from the claim payment. PSA payments are made quarterly.

Payment Implications : The CAH will receive 155% of 85% of the physician fee schedule for these services.


----------



## jturner32 (May 23, 2014)

Let me word this question differently. Pt was seen by Dr. A in group for the foot, a year later pt comes in to see Dr. B for the hand in the same group. Because Dr. B has a hand specialty and Dr. A doesn't can Dr. B charge a new pt ov with an AF modifer?


----------



## AprilSueMadison (May 23, 2014)

> "New patient" is defined as a patient who has not received any professional services from the physician within the previous three years. *Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.* If no face to face encounter has previously occurred between the physician and the patient, then the patient may be coded as a new patient the first time a face to face encounter does occur.



I don't know about the AF modifier, it isn't one we use.  Though from the above, it seems that if they are different specialties, they can bill the visit as a new patient visit.


----------

