New Patient vs Established Patient

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May 29, 2012

Question:

Our practice employs five general surgeons, a colorectal surgeon and a vascular surgeon. We were reading with interest the 2012 CPT changes and were wondering if this revision affects how we report new and established patient visits. They are all “general” surgeons, but the colorectal and vascular surgeons are credentialed with Medicare as colorectal and vascular surgeons respectively.

Answer:

Great question and one that was “clarified” in 2012 but for your purposes really changed nothing.  Medicare has recognized vascular surgery and colorectal surgery as different specialties within general surgery for some time. General Surgery is specialty code “20”; Vascular Surgery is specialty code “77”; Colorectal Surgery is specialty code “28”.   This allows you to bill a new patient the first time the patient is seen by a physician of their respective specialty.

What this means, and is clarified in 2012, is that the first time the patient is seen by the general surgeon, a new patient visit can be reported, and likewise for the vascular and colorectal surgeon. This, of course, assumes that the patient has not received any professional services from a physician, same group, same specialty/subspecialty within the past three years. If the patient was seen by the vascular surgeon in consultation in the hospital and then follows up in the office, it is an established patient, as the patient has received professional services. If the general surgeon on call sees the patient in the hospital and transfers care to the vascular surgeon and the first visit to the vascular surgeon is in the office, the vascular surgeon reports a 9920x.  While they are in the same group, the vascular surgeon is a different “specialty” as recognized by Medicare.