Wiki New versus new for 2012????

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RebeccaWoodward*

RebeccaWoodward*

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Have you read the definition of a new patient beginning 2012?

"Solely for the purposes of distinguishing between new and estab. patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT codes(s). 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"

So....does that mean, for example, if my hand surgeon treats a patient for the first time and he has previously been treated by our other ortho MD, he's no longer new?

What's your interp????
 
Yes that is how I take it. It was 2 years ago that I read that this was on the plan to implement. But your interpretation is how I understood it then and it does not appear that they have changed their intent.
 
Oh heck yeah! Where did you see this was being implemented for 2012, I had not noticed an implementation date, I just knew they were planning it.
 
Ah I do not have mine yet. I ordered it in July and still do not have it, I hate that we have to wait for the book to know what the changes are. I need that information now!
 
I think I'm making this harder than it really is or else I'm having a moment...

Looking at the decision tree in CPT 2012, it askes is it exact same specialty?....yes (my answer)....is it the exact same subspecialty?.....No (again my answer). The decision tree states "new patient". So...if ortho A treats patient and 6 months later ortho B (hand surgeon) treats patient, this should still be new...(??) Your take Deb? I'm really hearing alot of "buzz" supporting the opposite but I don't want to react to "hearsay" just yet....
 
RebeccaWoodward* said:
I think I'm making this harder than it really is or else I'm having a moment...

Looking at the decision tree in CPT 2012, it askes is it exact same specialty?....yes (my answer)....is it the exact same subspecialty?.....No (again my answer). The decision tree states "new patient". So...if ortho A treats patient and 6 months later ortho B (hand surgeon) treats patient, this should still be new...(??) Your take Deb? I'm really hearing alot of "buzz" supporting the opposite but I don't want to react to "hearsay" just yet....
Click to expand...

From the description here, my take would be that if the patient saw two different "hand" specialists, it would be established. But if they saw a "hand" specialist and then a "leg" specialist, that would be a different subspecialty. Ortho specialists, but two different subspecialties....just thinking...guess we will see.
 
This is good news, right? Before...if they were in the same practice and of the same specialty (ortho) they had to be established. Now that the decision tree has grown another branch....we're able to bill a new patient for a different sub specialist in the same practice setting.

ajs---that's how I interpreted it as well.

Deb, I can scan those pages of CPT to your email if you'd like (send me a PM).
 
Pam Brooks said:
This is good news, right? Before...if they were in the same practice and of the same specialty (ortho) they had to be established. Now that the decision tree has grown another branch....we're able to bill a new patient for a different sub specialist in the same practice setting.

ajs---that's how I interpreted it as well.

Deb, I can scan those pages of CPT to your email if you'd like (send me a PM).
Click to expand...

Thanks Pam Will do
 
Pam Brooks said:
This is good news, right? Before...if they were in the same practice and of the same specialty (ortho) they had to be established. Now that the decision tree has grown another branch....we're able to bill a new patient for a different sub specialist in the same practice setting.

ajs---that's how I interpreted it as well.

Deb, I can scan those pages of CPT to your email if you'd like (send me a PM).
Click to expand...

The more I read it, I think you're right. I hope so, anyway.
 
Nitpicking here, but...

Does it read "specialty AND subspecialty" or "specialty OR subspecialty"? This is crucial, especially as it applies to Rebecca's question. I am interested because we are struggling with payers over our critical care coding and whether the hospitalists and intensivists are the same "subspecialty" or not.
 
MnTwins29 said:
Does it read "specialty AND subspecialty" or "specialty OR subspecialty"? This is crucial, especially as it applies to Rebecca's question. I am interested because we are struggling with payers over our critical care coding and whether the hospitalists and intensivists are the same "subspecialty" or not.
Click to expand...


Hi, Lance. It reads "specialty and subspecialty". The decision tree on the following page illustrates a new patient visit can be billed if the provider is of a different subspecialty. I'll forward those pages to you. Pam
 
MnTwins29 said:
Does it read "specialty AND subspecialty" or "specialty OR subspecialty"? This is crucial, especially as it applies to Rebecca's question. I am interested because we are struggling with payers over our critical care coding and whether the hospitalists and intensivists are the same "subspecialty" or not.
Click to expand...

We're having the same issues. Margie Scalley Vaught is attending the AMA Symposium next week. She stated she was going to find out more details and let us know.
 
Thanks!

Pam Brooks said:
Hi, Lance. It reads "specialty and subspecialty". The decision tree on the following page illustrates a new patient visit can be billed if the provider is of a different subspecialty. I'll forward those pages to you. Pam
Click to expand...

Got them - thanks for the quick response!
 
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