Wiki Billing ? 99203 vs 99213

Create Wiki
L

Lucymedbilling

Contributor
Messages
10
Location
Astoria, NY
Best answers
0
Hi Guys,
I have a questions regarding group practice. It's a multi-specialty group and all doctors are linked to one TIN#. Let's say pt saw PCP and coming to see an eye doctor for the first time the following week, can I bill Initial office visit , since she didn't see the eye Dr. ever ? I know that we can bill as new pt, as long as there are different specialists involved within same tax id#, but some insurances denied and they changed 99203 to 99213.
It's like 99203 vs 99213 in multi- specialty group practice. Any help?
Thanks a lot.
 
Lucymedbilling said:
Hi Guys,
I have a questions regarding group practice. It's a multi-specialty group and all doctors are linked to one TIN#. Let's say pt saw PCP and coming to see an eye doctor for the first time the following week, can I bill Initial office visit , since she didn't see the eye Dr. ever ? I know that we can bill as new pt, as long as there are different specialists involved within same tax id#, but some insurances denied and they changed 99203 to 99213.
It's like 99203 vs 99213 in multi- specialty group practice. Any help?
Thanks a lot.
Click to expand...

I'd appeal based on different specialty..
 
I agree. Here's some ammunition:

By CPT definition, a new patient is “one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”

And from http://www.aafp.org/fpm/2003/0900/p33.html:

"In a multispecialty practice, a patient might be considered new even if he or she has received care from several other physicians in the group and a medical record is available. The distinguishing factor here is the specialty designation of the provider. For example, take a patient who has been seen regularly by the pediatrician in your group. The patient is now 18 years old and wants to transfer care to a family physician in the same group. When she sees the family physician, she’ll qualify as a new patient because the family physician is in a different specialty than her previous physician. This is the case even though the family physician might be treating her for an existing problem and referring to her established medical record.

"Medicare has a list of specialty and sub-specialty designations it recognizes for payment purposes. Other payers may use this same list or may recognize more areas of expertise based on credentialing information."

Good luck!
 
You must log in or register to reply here.
Top