Tammy Posted Mon 01st of August, 2016 10:29:37 AM
Can our spine surgeon charge a new patient level if the said patient has seen one of the general orthopods in the same office 6 months ago? The spine surgeon has a different taxonomy than the general orthopods, however they are all under the same tax ID number.
SuperCoder Answered Tue 02nd of August, 2016 06:51:00 AM
Since both the providers belongs to different specialty (Assuming that General Orthpods and spine surgeon has different Specialty/Group), so the patient would be considered as New to Spine Surgeon.
Tammy Posted Tue 02nd of August, 2016 08:44:35 AM
I don't feel as if the question was answered or I was possibly confusing in my asking, so I'm rephrasing it. The spine surgeon has the SAME office and SAME tax ID number as the other general orthopedic surgeons, does have different taxonomy. Can the spine surgeon charge new patients at today's visit if seen by the general orthopods 6 months previous?
SuperCoder Answered Wed 03rd of August, 2016 03:46:08 AM
According to the general coding guidelines by AMA (American Medical Association), An established patient is one who has received professional services from the physician of the "EXACT" same specialty and sub-specialty, who belongs to the same group practice, within the past 3 years.
So for your question,
1. If General orthopedic surgeon and spine surgeon belongs to same specialty under same Tax ID, then it will be considered as "ESTABLISHED PATIENT" but,
2. If General orthopedic surgeon and spine surgeon belongs to different specialty under same Tax ID, then it will be considered as "NEW PATIENT"