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Medical Coding School — Welcome!

Okay, what does sub-specialty mean in the new EM verbiage for distinction between new and established?

Okay so I wanted to show you, the definition of new versus established. I have to take my CPT manual apart from the spiral so I can get it under the document camera easiest.

EM Verbiage — What Does Subspecialty Mean

So this is on page 4 of the CPT Professional and it talks about new and established patient. It says, “Solely for the purposes of distinguishing between new and established patients. Professional services are those face to face, rendered by a physician and reported by a specific CPT code.” So a new patient is one who has not received any professional services from the physician or another physician. And this is what the questioner is asking, “of the exact same specialty and sub-specialty who belongs to the same group practice within the past 3 years.” So they’re focusing on specialty versus sub-specialty. So then I have an example here that I had for when I was teaching.

A sub-specialty would be like… say, for cardiology, they have a sub-specialty for cardio-thoracic surgeons. And it’s separate and that they’re going to do an entirely different eval than a regular cardiologist would. So cardiac… cardio-thoracic surgeons are going to do something more detailed so they are a sub-specialty. So if a patient is seeing 2 cardio-thoracic surgeons in the same specialty, they are established to that 2nd cardio-thoracic surgeon. But if a cardiologist refers them to a cardio-thoracic surgeon then… and that is the first time that cardio-thoracic surgeon is seeing them then they’re a new patient.

Okay now, another thing you can do…(15.00) let me start a new page here. I meant to do that before I started. I just typed this in and I say the same to my kids: “Google it then come back to me if you can’t figure it out.” So I put in medical sub-specialties and this one, this very first one came up here and it’s really neat. They actually go through and show you like here’s the anesthesia. Let me make this a little bigger. And it shows all the sub-specialties in anesthesiology. Now these aren’t necessarily used by Medicare but it just gives you an idea of how general medical specialties can be broken out into sub-specialties. You know, dermatology, emergency medicine is critical care… family medicine, there’s geriatric, adolescent, sleep medicine. Look at all these for internal medicine. So you get the idea.

Then there was on… I tought I had seen for cardiology but of course, I can’t find it right now. So if you want to see a particular specialty, just change it to cardiology sub-specialities and you can see all these different links come up. Okay so that’s how that one works.

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2016-11-20T23:38:47+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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