Wiki New Patient vs Established

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AR2728

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I feel confident in the my answer to this, however, I have a physician who frequently disagrees with me so I'm putting it out there before battle.

We have a general surgery office with two general surgeons. One of the surgeons -General Surgeon A- decided to take over seeing patients in our wound clinic one day a week. I know his patients can NOT be billed as new if they were seen by him within the last 3 years. However, what if General Surgeon B had a face to face visit with the patient within the last 3 years at the general surgery office where both practice. Can Surgeon A bill those out as new patients when seen at the wound clinic since he did not see them himself at the general surgery clinic?

I think based upon the new vs established guidelines that he can not. They are the same specialty under the same practice, the only difference is that he is physically seeing that patient under "wound" care vs general surgery.
 
AR2728 said:
I feel confident in the my answer to this, however, I have a physician who frequently disagrees with me so I'm putting it out there before battle.

We have a general surgery office with two general surgeons. One of the surgeons -General Surgeon A- decided to take over seeing patients in our wound clinic one day a week. I know his patients can NOT be billed as new if they were seen by him within the last 3 years. However, what if General Surgeon B had a face to face visit with the patient within the last 3 years at the general surgery office where both practice. Can Surgeon A bill those out as new patients when seen at the wound clinic since he did not see them himself at the general surgery clinic?

I think based upon the new vs established guidelines that he can not. They are the same specialty under the same practice, the only difference is that he is physically seeing that patient under "wound" care vs general surgery.
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You are absolutely right. Those patients would be established.
 
You are correct..the guidelines for this are very clearly stated in the CPT book. There's also a tree chart in the book to show your provider listing what qualifies billable as new pt if that would help :)
 
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Sorry I haven't replied for some time. I have issues logging into the forum at work.
Thanks for the feedback and support! It's difficult going head to head with a physician who leaves you questioning your knowledge. I appreciate the support from the forum!
 
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