When a newborn is not a new patient

In most cases a newborn is considered a new patient under CPT rules for purposes of coding and documenting an office visit. There’s one exception, however.

If you are in a group practice and another physician or qualified health professional in your group of the same specialty and subspecialty has treated the baby already (e.g., in the hospital), then the baby is not considered a new patient to you.

Some payers do not recognize subspecialties for the purpose of defining new patient services. In those cases, if a physician in your group of the same specialty already provided care, the baby is not a new patient to you, even if you and the other physician have different subspecialties. For example, if you and a colleague in your group are both family physicians, and your colleague is a hospitalist by subspecialty and has already provided care to the baby in the hospital, then the baby would only be considered a new patient to you if the payer recognizes subspecialties.

Read more Coding & Documentation tips in the latest issue of FPM.