Billing when in a multi-speciality group

[vitriol102]

Greetings!

Joining a multi-specialty group. Basically me (PM&R/pain management), spine surgeon (with 2 NP's) and general Ortho. If spine surgeon sends me patient I have never seen before, should be billed as new or established patient?

Here's the trickier question. NP works with spine surgeon one month. Sees patient. Few months down the line, I cover the NP (spine surgeon on vacation) and she refers the same patient she saw a few months ago, under spine surgeon, but for PM&R/pain management

Any input?

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[Njdevils30]

In my opinion, if you are all under the same umbrella (practice) then this is not a new patient, this is an established patient and should be billed as an established patient. If each specialty has their own practice then it would be a new patient but you have to be careful with this type of setup.

 

[j4pac]

Greetings!

Joining a multi-specialty group. Basically me (PM&R/pain management), spine surgeon (with 2 NP's) and general Ortho. If spine surgeon sends me patient I have never seen before, should be billed as new or established patient?

Here's the trickier question. NP works with spine surgeon one month. Sees patient. Few months down the line, I cover the NP (spine surgeon on vacation) and she refers the same patient she saw a few months ago, under spine surgeon, but for PM&R/pain management

Any input?

That would be a little bit risky. If the NP refers you patients and also works within your clinic I can see potential issues.

If you work within a hospital group and get consults from a different specialist, that should be fine.

 

[runfastnow]

You're stepping very much into gray area. During my training we had PM&R attendings bill under the PM&R department and under orthopedics depending on the location and to supposedly help with overhead costs which may provide a helpful example for you.

PM&R MD billing under PM&R dept was easy as any patient could not be billed as a new patient if seen by any other PM&R person billing under PM&R.

PM&R MD billing under orthopedics was more of a hassle as if PM&R wanted to bill as a new patient it needed to be coded as a new problem and consult from the ortho provider (which was fairly easy with the plethora of ICD10 codes).

 

[vitriol102]

Thanks for your input. This questions is turning out to be a lot more gray than anticipated.

 

[jonnylingo]

I'm in multi-specialty group. I get referrals from Occ Med, Ortho, Neurosurg, both from physicians and PA/NPs.

Bottom line -- If the patient has NOT seen a physiatrist, you bill it as a NEW patient, regardless of who has worked patient up.

The only caveat for me: some physicians in Occ Med are physiatrists. If they send to me for second opinion, it's billed as a f/u.

 

[PMR2008]

Agree with above.It is actually pretty clear.
"A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. "
So if a general physiatrist sends a referral to a pain physiatrist in the same group it would be a new patient.

New vs. Established Patients: Who’s New to You?

Is the patient new or established? Follow these guidelines to make the right choice every time.

www.aapc.com

 

[lobelsteve]

In my opinion, if you are all under the same umbrella (practice) then this is not a new patient, this is an established patient and should be billed as an established patient. If each specialty has their own practice then it would be a new patient but you have to be careful with this type of setup.

Completely incorrect.