Wiki New vs. established

[akj]

I have patient that has established care with Dr. Smith, who is employed by a large medical group with many primary care physician offices, all billed under the same NPI and tax id#. In the last three years, this patient has only seen Dr. Smith, no other family physicians and no mid levels. Dr Smith retires, and Dr. Jones is employed to take over Dr. Smith's patients. Dr. Jones has a new Nurse Practitioner working under him. This new NP sees the patient in question for the first time. Should the service be new or established?

Any input would be appreciated, as well as insight to where I can find supporting documentation.

 

[CatchTheWind]

Established, because it is the same practice and same specialty & subspeciality. Look in your CPT book, at the beginning of the E/M section, for the guidelines.

 

[akj]

I agree it should be established. It is another coder's position that it would be a new visit because the Nurse practitioner a different specialty (NP vs. physician). We all just want to do things right!

 

[jroxas]

Hi
I agree with established E&M. Bec the nurse practitioner is the rendering provider but the supervising provider is still the physician of the same group and specialty.
Jerry E. Roxas, CPC

 

[MarcusM]

Established patient, but it may take more time to get the new provider up to speed, review of records, etc so it MAY be a higher level visit, if documentation supports. The carriers will frown heavily if you bill a new patient...their systems cross check this stuff and they may down code from new to lower level established.....