Pediatric Coding Alert

Question: If a provider of a different specialty within the same group sees the same patient on a different day (or even the same day), can they charge a new patient visit even though the patient has been to the practice before? 

Answer: Typically, yes, but it depends on the insurer’s recognition of that specialty. Some payers consider neonatal specialists the same as pediatricians from a specialty standpoint, for instance, even though Medicare gives them separate specialty designations. So if the insurer allows it, then you can absolutely bill a new patient visit in that situation.