new patient

edited May 2017 in Primary Care
I understand that a new patient is “new” (i.e., submit the claim using the new patient office visit E/M codes) if they have not been seen in our office by a provider in the SAME specialty for three years. Assume a pulmonary specialist see the patient in our office. Then, that pulmonologist leaves the medical group. Then, we hire a new pulmonary specialist. The new pulmonologist now sees this same patient. I assume we still can’t bill a new patient visit with the new pulmonologist even if the first pulmonologist is no longer in the group, correct? Thanks. Rich Fairley, MD, Dubuque IA


  • Is anyone else getting denials (Novitas) for new patients when a PA-C or CRNP from Family Practice sees patient & then 2 years later is seen by a Cardiothoracic surgeon? We are getting denied because “the provider at issue is a non-physician practioner (NPP); NPPs are not assigned sub specialties by CMS. Therefore no payment can be effected.” Losing on first appeal.
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