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Janice Posted Mon 30th of October, 2017 09:36:06 AM
if i have 22 doctors in my office but they all do different things if 1 refers to another can i code a new visit if they have seen another doctor in my office with a different specialty???
SuperCoder Answered Tue 31st of October, 2017 06:25:31 AM

Hi,

As per CMS New patient visit can be billed if the patient has not seen a physician of the ''same specialty, same Tax ID" within the past 3 years. Since if patient refered to different specialties, the New Patient visit code could still be billed, even though physician share the same Tax ID. If one provider refers to another provider under the same Tax ID, then that would NOT qualify as a new patient.

Hope this helps!

Janice Posted Fri 22nd of December, 2017 09:16:11 AM
you said if patient refered to different specialties, the New Patient visit code could still be billed, even though physician share the same Tax ID. If one provider refers to another provider under the same Tax ID, then that would NOT qualify as a new patient. im not sure i understand your answer doctor 1 is a cardiologist doctor 2 is a interventional cardiology they share the same tax id because they are in the same practice can they both have a new patient visit with the same patient???
SuperCoder Answered Tue 26th of December, 2017 04:55:53 AM

CPT rules and Medicare rules both allow the new patient visit rules in your scenario, which is very common in large multi-specialty groups where all specialties bill under the same tax ID.

A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

In a single-specialty practice, the patient’s encounter should be reported with a code in a new patient category only if no physician or other provider who reports services using CPT codes in that group has seen the patient within the last three years.

In a multispecialty practice, a patient might be considered new even if he or she has received care from several other physicians in the group and a medical record is available.

The Centers for Medicare and Medicaid Services (CMS) developed a new specialty code in interventional cardiology to reflect its distinction from other specialties. The ACC supported a request from the Society for Cardiovascular Angiography and Interventions to obtain the new designation, which allows CMS to distinguish an interventional cardiologist from a clinical cardiologist when billing for Medicare services

http://www.acc.org/tools-and-practice-support/practice-solutions/coding-and-reimbursement/cms-assigns-interventional-cardiology-specialty-designation

Hope this helps!

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