patient new to physician

I am receiving some conflicting information so I wanted to put this out the list serv. We have a Medicare patient that was seen in our practice by one of our Physical Therapist, referred from a outside physician. Now the patient is being seen at our practice by one our physicians. Can we bill this patient as a new patient? They have never seen one of our physicians or physician assistants.
Thank you in advanced for any information

Stacey Delser, CPC
Business Office Supervisor
Ortho Montana
Office 406-238-6537
Fax 406-238-6599


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  • edited May 2017
    Per AMA guidelines, if it is a different specialty / subspecialty they can be considered new. I will throw out that that if you are billing with the same tax id and taxonomy, the payor claim scrubbers might flag it as existing.

    Michelle Suitor, CPC
    Clinical Techincal Editor
    DecisionHealth LLC
    2180 So 1300 East #260
    Sugar House, UT 84106
    Tel (801)365-2206

  • Yes different specialty allows for it to be billed as new.

    Ruby Woodward
    Sent from my iPhone

  • ​Do your PTs and MDs bill under the same TIN? For the most part, the PT & MD are different specialties (and recognized as such) and therefore should be new patient.

    Maxine Lewis, CMM, CPC, CPC-I, CPMA, CCS-P

    Main: 513-771-7070
    Direct: 513-672-4363

    Fax: 513-326-7640

    200 Northland Blvd

    Cincinnati, OH 45246

  • Yes, we bill under the same TIN. Running into denials because we bill as a group even though they are completely different specialty.

  • You should be able to appeal. Not only are they different specialties but the focus of their eval is completely different. This of course is all assuming that your therapists are credentialed and are being billed under their own provider numbers. Made that assumption based upon the fact they have treated prior to the physician seeing the patient.

    Ruby Woodward
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