Wiki Office Consultation with Medicare Patient

[uncpncoding]

Cardiologist refers his medicare patient to the electrophysiologist/cardiologist(EP) in the same practice. The patient has not seen the EP before. The clinical manager says this should be coded as a NEW patient visit. Per E/M guidelines on pg4 CPT-2014, should it not be ESTABLISHED?

 

[mhstrauss]

Cardiologist refers his medicare patient to the electrophysiologist/cardiologist(EP) in the same practice. The patient has not seen the EP before. The clinical manager says this should be coded as a NEW patient visit. Per E/M guidelines on pg4 CPT-2014, should it not be ESTABLISHED?

If the EP is registered with Medicare as a different subspecialty than the cardiologist, then yes, the EP visit can be new patient. You can search both providers by their NPI number on the NPPES website to find out exactly how they are registered. Per CPT E/M guidelines, a new patient is one who has not been seen by the same specialty OR SUBSPECIALTY in the same group practice.

Hope this helps!

 

[uncpncoding]

Yes, thank you.

 

[shellysk8]

Subspecialty

Just an FYI - some commercial payers do NOT recognize subspecialty, only specialty. Therefore, the claim may be downcoded to an established patient or perhaps denied by those payers. UnitedHealthcare is one that I am aware of.