FNP's

We have 2 who work in the office with a specialist. We have 5 who work in satellite clinics. All under the same group number. If one from outside office send a patient the one working with the specialist is the patient new or established.

Mar 18th, 2013 - bsergi 110

re: FNP's

If patient has been to the group before then not new.

Mar 18th, 2013 - rphelps 615 1

re: FNP's

But if the patient had been seen by the specialist he would have been new, correct?

Mar 18th, 2013 - Codapedia Editor 1,399

re: FNP's

If processing according to Medicare rules, all NPs are one specialty. So, an NP working in Family medicine and an FP working in Oncology are one specialty. It is based on the two digit taxonomy code. Seth Canterbury explains it very well here:

http://codapedia.com/article_475_NUCC-Taxonomy-Codes-Vs-Medicares-2-Digit-Specialty-Codes.cfm

However, one of the Medicare Contractors is now basing new/established based on the specialty with which the NP works.

Many privates designate the NP or PA as specialty or primary care. That would make it a new patient if the NP at the different location was a different specialty.

If the entire practice is the same specialty, then established.

Looking at the CPT® chart at the front of the CPT® book doesn't help: it doesn't define "exact same sub specialty" in terms of physicians versus PAs or NPs.

Mar 18th, 2013 - bsergi 110

re: FNP's

Yes, if not within same specialty.
I have seen denials/recoding occur when there is "lower" specialty vs. "higher" where the lower more general specialty would be considered within the scope of the higher more skilled specialty. For es. if patient sees a hand surgeon same day as (or later down the road) a general orthopedic doc..

Mar 18th, 2013 - Codapedia Editor 1,399

re: FNP's

FYI, hand surgery and Orthopedics have different two digit specialty codes.

Mar 18th, 2013 - bsergi 110

re: FNP's

A hand surgeon would have both specialties. Hand surgery is a subspecialty.

Mar 18th, 2013 - Codapedia Editor 1,399

re: FNP's

Not according to Medicare when enrolling. An Orthopedist would have to select either hand surgery or Orthopedics as the first specialty. Claims are processed based on the first specialty selected. The second specialty is added, but does not determine claims processing.

Mar 18th, 2013 - bsergi 110

re: FNP's

Good to know for Medicare...