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krystim1109

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If a physician leaves his practice to join a different primary care group and one of his patients follows him to that group, is that patient considered new or established?
 
New: HAS NOT Received any service from the physician(or from the same group) with in 3 years; exact same specialty; and subspecialty.

Established: HAS Received any service from the physician(or from the same group) with in 3 years; exact same specialty; and subspecialty.

That's putting it simply.


CPT Guidelines.
 
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Medicare guideline:
1. Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.7, Subsection A
2. 1995 CMS Documentation Guidelines

Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.
Beginning in 2012, the AMA CPT instructions for billing new patient visits include physicians in the same specialty and subspecialty. However, for Medicare E/M services the same specialty is determined by the physician's or practitioner's primary specialty enrollment in Medicare. Recognized Medicare specialties can be found in the Medicare Claims Processing Manual, chapter 26
 
ok, so my doctor leaves his practice and goes to a new one, I see him and Im considered an established patient as his new office since I have seen him within the last 3 years....

what if my physician joins a new practice and i follow to the new practice, but I havent seen him yet... i get real sick , my doctor is off so I see someone else in his group.....

so Im seeing a new physician, under a different tax ID......


new or established?

they guidelines arent clear , i think it based on interpretation. I agree that it should be a established patient but my consultant and boss want something that spells it out.
 
krystim1109 said:
ok, so my doctor leaves his practice and goes to a new one, I see him and Im considered an established patient as his new office since I have seen him within the last 3 years....

what if my physician joins a new practice and i follow to the new practice, but I havent seen him yet... i get real sick , my doctor is off so I see someone else in his group.....

so Im seeing a new physician, under a different tax ID......


new or established?

they guidelines arent clear , i think it based on interpretation. I agree that it should be a established patient but my consultant and boss want something that spells it out.
Click to expand...

Theoretically this could qualify as a new patient. If, however, the new physician is seeing the patient because they are covering for the other physician, then CPT directs you to treat them the same as the original provider would. Meaning they would be established.

Hope that helps,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC
 
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