Wiki Referrals within Group Practice for different specialty

[bones555]

We are a 6 physician group 5 are Orthopedics and 1 physiatrist. If physiatrist refers to the ortho he thinks he can bill new pt code vs. established code and vice versa. We've billed new pt code and was downcoded to established pt. Docs want written verification that this cannot be done. Any thoughts on this would be appreciated!!!

 

[cluke]

CPT clearly states that to be a new patient is one who has not received professional services from the physician or another physician of the exact same specialty and sub-specialty who belongs to the same group practice.

You would need to check with the credentialling department for the carrier to see how they have the providers credentialled. If they are of a different specialty and subspecialty, I would appeal this downcoding.

Cindi Risinger CPC

 

[bones555]

Thanks for the response! I will verify that.