NANOSNET

Hi everyone, I have a question about E&M Coding for Neuro Ophthalmology patients - I thought with the new guidelines in 2023, any patient that is seen by us or a different specialty within the same specialty group, it is considered a new patient for us?

For example, if a patient has been seen by Cornea or Retina or Glaucoma within my group practice and they bill the patient for a new visit, but they subsequently referred the patient to me and I see them within the next few days or weeks, can I bill it as a new patient since it is new to my sub specialty?

Does it help if the other members of the group are billing Ophthalmology codes and I am billing E&M visit code with time based billing?

If none of the above applies, how is everyone justifying generating revenue for new visits since they take up a lot of our time?

It depends upon how your group is structured- talk to your practice manager- if you share the same Tax ID number, then unfortunately you must bill as a F/U.

I am in the same boat, despite the fact that we have a different CMS taxonomy number, as my co-faculty are structured to bill under the same tax ID, I am stuck with billing as a f/u.

That being said, if you spend more that the maximum level 5 time in f/u you may be eligible to use extended time code(s)

Got it, thanks!

In my general experience, even if something is allowable by the codes, you can spend alot of time fighting with your billing/coding dept to do it a certain way, but then they insist you do it their way -- for example, trying to get them to code it as a new patient because you are a 'different specialist' within the 'same group'. 

That is not correct- we pursued taxonomy code primarily to assist with our members not getting profiled and compared to general neurologists and ophthalmologists in their billing profiles.  But even with the taxonomy code being unique, if you share a same tax#, you are stuck.

I'm not sure that is true Larry. A university may have the same tax ID for all its doctors, but a patient seen in neurology for the first time is new even if they have seen a doctor in another department.

True! Neuro Ophthalmology should be considered a different subspeciality no matter which department we working in, given the complexity and long duration of these requirements! 

It is illogical to first bill them as follow ups and then complain about the low revenue that neuro ophthalmology is generating! 

Logic is most certainly not necessarily the operant word when looking at how CMS decides its operations

Interesting Larry. At Emory, the Neuro-ophthalmology bill is based in the department of ophthalmology and we use the Neuro-op taxonomy code when we see a patient in the neuro-op clinic. If this patient seen by another subspecialty that uses a different taxonomy code in our department (like glaucoma or retina), we can bill as a new patient. 

I guess, that may vary among institutions? 

Valerie

Sorry, see below with less typos and less "Frenglish..." so that you can understand what I meant...

Agree with Dr. Frohman, 

Sorry, I should clarify that I'm not using a different taxonomy # and am in a private practice setting. That likely plays a role as well.

Actually, I just looked at a Website which contradicts what I said. And apparently they do have to be in the exact same specialty to prevent you from billing as a new patient. Sorry for my misleading comments above.

Matt

And can you post that web site. I have been told by billing "experts" at Columbia Pres that I cannot bill for a referral from within my department as a "new Patient". 

Scott Forman

It is not one size fits all!  It depends upon how your practice has structured your groups and assigned tax ID's.  In theory, a department of ophthalmology could have a distinct tax ID for each division/specialty, and then one could bill as long as the patient was new to your division.  But I think most practices have not structured that way- you need to talk to your administrative experts to learn about how your group is structured to know the answer to this question.

I can't promise you that this is accurate as I simply posed the question to A I

https://www.kzanow.com/coding-coaches/different-specialties-same-tax-id

Looking forward to seeing everyone in Boston.

Matt

I got audited by Mcare three times for possible use of botox for cosmetic reasons when its really because They don't recognize the difference between a general ophthalmologist and a Neuro-ophthalmologist. Of course I saw 30 times more patients for botox rx as they all send their patients to me. 

Same issue

Scott Forman

Actually, that's not the case to the best of my knowledge. If you are in the same group practice billing under a common tax ID number, just as Doctor Frohman said, that patient is a follow-up to you as the requirement for a new patient is that it hasn't been seen by you or another member of the same group practice within three years. I do not believe that having the separate taxonomy number makes a difference.

Matt

I must unfortunately totally agree with Matt Kay. Now that I am at Columbia Presbyterian, this fact has faced me many times in seeing patients referred by others within the Columbia Framework. You may not consider that a new patient. Columbia Pres hires specialists to let you know this and it was one of the first things I learned when I joined in November. 

Scott Forman, MD

As I have stated, within the same group of say eg, Ophthalmologists, if a cornea or retina doc refers to them a new patient to you, the patient is no longer "new" to the group. You bill a comprehensive or complex follow up. You also get to bill fields, sensorimotor, OCT or photos, etc and that is plenty of reward in these days.No??