Wiki Initial Inpt vs New pt OV

[christy2107]

We are an Orthopaedic Group with several physicians. Two of our physicians are credentialed under Taxonomy 208100000X-sports medicine.

If one of our sports med providers bills a 9922X initial inpatient, can the 2nd sports med provider bill a 9920X New patient office for the same patient or is this considered an established patient? The physician billing the 9922X only assesses in patient referrals and the other assesses chronic cases (non surgical) in the office visit setting only.

 

[MikeEnos]

If I"m understanding you correctly, the patient is established. Even though the patient has not seen that provider before, they have had face-to-face services by another provider in the same group with the same specialty within the last 3 years.

When the provider is considering the medical decision making complexity however, it is a new problem to the examiner. Keep that in mind.

 

[christy2107]

If I"m understanding you correctly, the patient is established. Even though the patient has not seen that provider before, they have had face-to-face services by another provider in the same group with the same specialty within the last 3 years.

When the provider is considering the medical decision making complexity however, it is a new problem to the examiner. Keep that in mind.

First visit was initial inpatient - not seen by any provider within the group. Physician wants to bill initial follow up care in office as New Patient 9920X since it is a different doctor.

 

[MikeEnos]

First visit was initial inpatient - not seen by any provider within the group. Physician wants to bill initial follow up care in office as New Patient 9920X since it is a different doctor.

OK well either I'm misunderstanding, or you are contradicting yourself. You originally made it clear that there are 2 sports medicine providers. You asked "If one of our sports med providers bills a 9922X initial inpatient, can the 2nd sports med provider bill a 9920X New patient office for the same patient or is this considered an established patient?" The answer to that question is no, as detailed above the patient would be considered established for the second encounter.

Now you are saying that the 9922X was not performed by a provider in the same group. That pretty much changes everything, so I'm not sure what your question is.

I think what you need to understand is this:
Ask yourself: Has this patient received professional services from you or another physician of the same specialty who belongs to the same group practice, within the past three years?
If the answer is no, this is a new patient.
If the answer is yes, this is an established patient.

Here is a flow chart that further illustrates the point. Just replace FP with Sports Medicine provider.