tci E/M Coding Alert - 2023 Issue Q4

Reader Question: Specialties Matter When Categorizing Patient Visits

Question: If a patient sees one ophthalmologist in our group practice, then one year later sees a different eye care provider in the same practice, should we bill the subsequent encounter as a new or established patient visit? Connecticut Subscriber Answer: It depends on the second provider’s specialty. CPT® defines a new patient as “one who has not received any professional services from the physician … or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” The Centers for Medicare & Medicaid...

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