EM Coding Alert

Question: If a patient sees one surgeon in our practice, then one year later sees a different surgeon in the same practice, is this a new or established patient visit?

Michigan Subscriber

Answer: If the first and second surgeons practice with the same taxonomy code within the same practice, you should code the second visit with the second surgeon as an established patient E/M service.

CPT^® defines a new patient as “one who has not received any professional services from the physician/ qualified healthcare professional or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”

Taxonomy: The National Uniform Claim Committee (NUCC) provides a taxonomy code set that lists unique 10-character codes that classify a physician’s provider grouping (such as DO or MD), classification (specialty, such as surgery), and subspecialty.

Key: For a physician practicing with a different taxonomy code, the first patient visit is a “new patient” even if another physician in the same practice has already seen the patient within the past three years. This would be true even if both providers are billing under the same group taxpayer identification number (TIN).