Primary Care Coding Alert

Question: We are a multispecialty group with internists, family practitioners and pediatricians working in the same office. If an internist sees a patient for the first time, but the patient was previously seen (within the past three years) by a different primary-care specialist within our office (i.e., family practice physician), is the patient new to the internist or established?

Teresa Kroll, Promedicus Health Group
Buffalo, N.Y.

Answer: According to the CPT guidelines a new patient is one who has not received any professional services from the same physician or another physician of the same specialty within the same group during the past three years. The key words, in this case, are same specialty. Therefore, if your patient was seen by a family practice physician and then was seen by a gynecologist within the group, you would be able to bill a new patient visit with the gynecologist.

Coders should note that Medicare policy requires that the encounters be face-to-face a difference from CPTs use of the term professional.

Answered by Kathy Zmuda,CPC, lead inpatient coder, Cigna Health Care of Arizona in Phoenix.