Wiki Help with New Pt Decision Making ...

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llsimmons0824

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Our group just had a doctor from another practice join. Let's call him, Dr. A. He is not available and one of his patients from his previous practice needs to be seen. One of the other docs in our group who has never met this patient and there is no chart sees the patient. Would they still be considered established? The guidelines do not seem seem specific enough to understand. I know that Dr. A would still bill them as established because he has seen them in the past 3 years, but say, Dr. B or Dr. C see them - they are technically new patients to these docs?
Any input will be greatly appreciated.
Thank you!
 
As long as the doctors are in the same practice, and they see each others patients, they will be considered established patients unless the doctors are of different specialties. for example: An orthopedic and a medical doctor is in a practice together and the medical doctor sees the orthopedic's patient, the medical doctor can charge a new patient because his specialty is different.:)
 
In theory they are new patients to your providers but if you read in CPT regarding physicians covering for other physicians it states the covering physician should bill like the regular physician would have. I am off site and don't have my book in front of me to give you the exact wording, sorry.

Since this patients intent was to see the provider they had already established with I would consider them established. Had that not been their intent and they were just establishing with your providers then I would bill them as new since they have not established with your group yet, they are only established with the new physician and the group he came from.

Just my take on it,

Laura, CPC, CPMA, CEMC
 
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