Wiki When is a "new" patient a "new" patient ?

[vstoots]

If someone could answer the following question and provide guidance to find the CMS guidelines to this situation I would much appreciate. Thanks, Vicki

1. A doctor XYZ joins our practice and spends 6 months with us and then decides to retire (we purchase his practice).
2. After his retirement with us, one of Dr. XYZ?s patient calls the office to be seen to one of our current doctors.
3. This patient was not seen by Dr. XYZ during his six months with us, but was seen by him sometime within the last 3 years.
4. Can our current doctor bill a new patient E&M code when he sees Dr. XYZ?s patient? (since Dr. XYZ joined our practice, we are unclear if all his patients would be considered existing patients even if they weren?t seen during his 6 months with us).

 

[vincil]

From the CMS FAQ page
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 (http://www.cms.gov/manuals/downloads/clm104c26.pdf). You may contact your Medicare claims processing contractor to confirm your primary Medicare specialty designation.
(FAQ1969)