General Surgery Coding Alert

Same practice and specialty no longer preclude new patients.

You've faced the dilemma before -- when an established patient presents to your practice to see a different physician that he's never seen before, should you report a new patient office visit code? With a revision to the "New and Established Patient" section of the CPT® 2012 manual, you'll find a solution that could affect your bottom line.

'Subspecialty' Rules the Day

Currently, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, such as an E/M or other face-to-face service, from the physician or physician group practice -- within the same physician specialty -- within the past three years.

Clarification: CPT® 2012 takes that definition a step further, now stating, "A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years." The portions of the description that are new for 2012 are underlined.

What this means to you: If your practice employs various subspecialists, CPT® now makes it clear that you can bill claims for patients who see different doctors with different subspecialties using a new patient code [such as 99201-99205], according to Peter A. Hollmann, MD, chair of the CPT® Editorial Panel, during the CPT® 2012 Annual Symposium in Chicago on Nov. 16:

Example: A general surgery practice employs a general surgeon and a vascular surgeon, and both physicians are classified as these separate specialties with their payers. The general surgeon refers a patient to the vascular surgeon for consideration of a peripheral vascular angioplasty. In this situation, the visit with the vascular surgeon should qualify as a new patient visit, assuming the payer accepts these CPT® rules.