Forum - Questions & Answers
New Patient 2012
I read that the definition of a new and established patient had been revised and this applies to specialty practices. The article is written by Therese M Jorwic, MPH, RHIA, CCS, CCS-P and states that if a patient is seen by one physician in a practice and then goes to another physician in the practice with the same specialty, but a different subspecialty that the patient is considered a new patient. Is this correct? How do you notate that a provider has a subspeciality? Any advise on this topic would be great.
Thank you.
re: New Patient 2012
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.
re: New Patient 2012
CMS addressed this at the Open Door Forum Jan 24 2012 and confirmed that they are not changing claims processing based on the CPT® definition and don't plan to make any changes.