Wiki Pain Management/Physical Medicine

[hammonds77]

We have a pain management doctor in with our Orthopaedic practice with sane Tax ID, he thinks if he refers patients to one of the orthopaedist they can bill new patient and vice versa, I thought it would have to be established. Does anyone have info on this?

 

[rlewis3504]

Question: We have a pain management doctor in with our Orthopaedic practice with sane Tax ID, he thinks if he refers patients to one of the orthopaedist they can bill new patient and vice versa, I thought it would have to be established. Does anyone have info on this?

Reply: We have the same situation in our office. Our pain guy is listed as a separate specialty (anesthesia), so a referral may or may not be new or established, depending on the referral and the physician being referred to.

Hope this helps.

 

[hammonds77]

Thank you, its a referral from one physician to another in the same office. Lets say Dr X has a patient comes in with Shoulder pain but also complaints of back/neck pain so DR X refers patient to DR Z within the same physician practice which is using same Tax ID. Dr. Z wants to be a new patient visit even though patient is established with practice?

 

[mhstrauss]

Thank you, its a referral from one physician to another in the same office. Lets say Dr X has a patient comes in with Shoulder pain but also complaints of back/neck pain so DR X refers patient to DR Z within the same physician practice which is using same Tax ID. Dr. Z wants to be a new patient visit even though patient is established with practice?

The new/established patient guidelines are based on how the providers' NPI's are registered--Tax ID is not a factor. If they are registered under different specialties in NPPES (which it sounds like they are--one ortho, one pain), there should not be any issue with both billing new patient visits, even though they are in the same practice. Refer to the CPT New and Established Patient E/M guidelines; there are statements in the first couple paragraphs regarding "exact same specialty/subspecialty", which your providers are not.

HTH!