Wiki New patients

[kfenton]

As a large multispecialty group, we have patients who see multiple physicians that are of different specialties. With that being said, if a patient is an established patient of a nephrologist whose primary taxonomy code is listed as internal medicine - nephrology and subsequently the same patient sees our internal medicine physician whose taxonomy code is internal medicine, can we bill that patient as a new patient for the internal medicine visit.

What happens if the nephrologist is set up as the patient's PCP with their insurance company, can the internal medicine physician still charge for the new patient visit?

Second, we are aware of the "three year" rule for new patients, however does the physician's documentation need to indicate new patient status within the note?

Looking for some insight...

Thank you for any assistance.

 

[tracyp38]

A new patient is one who has not received any professional services from the
physician, or another physician of the exact same SPECIALTY AND SUBSPECIALTY
who belongs to the SAME GROUP PRACTICE, within the past three years..Nephrology is the subspecialty of internal medicine

 

[kfenton]

Yes, but these physicians are board cerfitied nephrologists.

Does the physician's note need to state that it is a new patient visit? Or is it sufficient that we could prove new patient status per appointment type in the physician's schedule?

Thank you.