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mreed63

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Hi team members! I have medical (MD's, NP's) and behavioral health (LMSW's) providers who render services under the same NPI group number and tax ID number. If the patient sees an LMSW and then a medical provider, is the patient considered new for the medical provider, as it is a different specialty? They are both under the same NPI group number and tax ID number. My understanding has been if services are billed under the same NPI and tax ID, a new patient would only be billed once.

Appreciate any clarification that can be offered! Many thanks! :)
 
CPT: New Vs Established.

1. Received ANY professional service from the physician or another physician in group of same speciality with in 3 Years? If NO = New Patient
2. Exact SAME speciality? If NO = New Patient
3. Exact SAME subspecialty? If No = New Patient

Otherwise Established.

Professional services are face to face rendered by the physician or Qualified health care who can do E&M services.

Read your CPT in the E&M section for more information.
 
New or established...

I understand those guidelines. My question is whether or not sharing the same NPI group and/or tax ID come into play.

Thanks.
 
I work in a practice with NP's, MD's, DO's, PAC's, LISW, LMHC. We do not bill new patient when they see different specialties in our practice. Although we seem to be told it IS appropriate if they are different specialties, this is not always easy to identify if its their first visit with a particular specialty and also very hard to explain to patients why they may get billed the new patient code several times within our same practice. Therefore, we only charge it the first time :)
 
Thanks, Amber. Makes sense. It sounds like technically it's correct to do so, but should be evaluated from a workflow standpoint. Appreciate your help! :)
 
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