New versus Established and Change of Tax ID#

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New versus Established and Change of Tax ID#

Postby Charlene » Fri Feb 23, 2018 12:33 am

:D Hello,

We have an internal debate going on the rules for New versus Established patient specifically for patients following a provider from one local clinic to another local clinic within the 3yr period (same rendering provider NPI with different Group Tax ID numbers).

In this situation; would the patient be considered "New"; since they have never been seen at the new Group location ? Or are they Established because they have already seen the provider within the 3yr period ?

Please site the guidelines supporting your response.

Thanks,
Charlene DiGiacomo, COC
Charlene
 
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Re: New versus Established and Change of Tax ID#

Postby Bill_Wong » Fri Apr 13, 2018 4:21 pm

Hi Charlene,

It will be considered established patient, if the patient comes within the 3 years time frame. Here is a Q/A from Noridian. See "Claim Examples 2."

A patient sees Dr. Smith, a cardiologist, for follow up care at "Clinic A."

Date of Service Service Provided CPT Code
06/23/17 Established E/M 99213
Dr. Smith leaves "Clinic A" and joins "Clinic B." The patient follows Dr. Smith to "Clinic B."

Date of Service Service Provided CPT Code
7/15/17 Established E/M 99213
Although Dr. Smith is at a different clinic, the patient is still an established patient with him. Dr. Smith's NPI is used to track if the patient has been seen within the previous 3-years.


I have attached the full article from Noridian's Website. I have also attached their E/M Webinar that states this on slide 14.

Bill
Attachments
New Patient vs Established Patient Visit - Noridian.pdf
(143.38 KiB) Downloaded 108 times
New Patient Versus Established Patient Visits Presentation.pdf
(595.84 KiB) Downloaded 11 times
Bill Wong, CHC, CHPC, CCS, CPC, CPMA, CDEO
Corporate Compliance Analyst
Seattle Children's Hospital
Seattle, WA
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Re: New versus Established and Change of Tax ID#

Postby Charlene » Fri Apr 13, 2018 5:16 pm

Thanks Bill..... great information !
Charlene
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Joined: Fri Feb 23, 2018 12:03 am


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