Hand surgeon as an Orthopedic subspecialty.

Mary LeGrand with Zupko and Associates taught at a coding seminar I attended that a patient can be classified as a "new patient" if they see a hand physician, even though they had seen another knee or shoulder physician in the same Orthopedic practice within the previous 3 years, as a hand surgeon is a different subspecialty. Terry Fletcher with McVey Associates today taught that CMS does not recognize hand as a different subspecialty, thus the patient would be "established", if they had been seen by anyone in the practice within the previous 3 years. So can we bill the hand physician's services as "new" for other carriers, just not Medicare? Or should we always bill the patient as 'established' if seen by anyone in the practice in the previous 3 years regardless of the carrier?
Thank you
Elaine in Phoenix, AZ

hand surgeon as its own specialty

Here's the definitive source of the answer: Go to the CMS website, and download the 855i (enrollment form) and see if the specialty in question is listed as a specialty by CMS. It is.

Whether a patient is new or established depends on whether CMS has listed the specialty with a two digit code. Hand surgery is a different specialty than Orthopedics. It doesn't always make sense: Electrophysiology isn't separate from Cardiology.

In this case: believe Mary.

Specialty designation

Medicare:
Orthopedic - 20
Hand surgery - 40
Different specialty designation