I asked one of our leaders this question and I agree with Dr. Ed Pryzchchek: in order to be considered a new patient, they cannot have been seen by “…the exact same specialty and subspecialty, who belongs to the same group practice, within the last 3 years.” He made a very good point that “however, as I thought about this, I could think of 1 possible exception. That would be if the ortho group already has 1 podiatrist who actually saw this patient within the last 3 years, and now they are adding a 2nd podiatrist who is now seeing this patient. If an ortho group has now a 2nd podiatrist in the group, the one asking the question, it would not be new in this scenario.”
The coding for new or existing patient is based upon the individual providers NPI number. If the patient was never seen by you, even though they were seen in the orthopedic practice and any old claims had the practice NPI, you can still bill this patient as a new patient, if they are new to you, utilizing your personal NPI number.
QUESTION: I have closed my office, and I joined an orthopedic group. If I am seeing a patient that is new to me, but has been seen within 3 years by other doctors in the practice, am I allowed to bill it as a new patient encounter? Thank you.
I asked one of our leaders this question and I agree with Dr. Ed Pryzchchek: in order to be considered a new patient, they cannot have been seen by “…the exact same specialty and subspecialty, who belongs to the same group practice, within the last 3 years.” He made a very good point that “however, as I thought about this, I could think of 1 possible exception. That would be if the ortho group already has 1 podiatrist who actually saw this patient within the last 3 years, and now they are adding a 2nd podiatrist who is now seeing this patient. If an ortho group has now a 2nd podiatrist in the group, the one asking the question, it would not be new in this scenario.”
Hello djfreedman.
The coding for new or existing patient is based upon the individual providers NPI number. If the patient was never seen by you, even though they were seen in the orthopedic practice and any old claims had the practice NPI, you can still bill this patient as a new patient, if they are new to you, utilizing your personal NPI number.
QUESTION: I have closed my office, and I joined an orthopedic group. If I am seeing a patient that is new to me, but has been seen within 3 years by other doctors in the practice, am I allowed to bill it as a new patient encounter? Thank you.