Fam Pract Manag. 2024;31(3):34
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Author disclosure: no relevant financial relationships.
COVERING FOR OTHER PHYSICIANS
I am a solo physician who has an arrangement with physicians in another practice to provide coverage for each other's patients. When I cover for one of them and provide care to their patient for the first time, can I report a new patient service?
No, you cannot report a new patient service if the patient is established within the practice you're covering for. Per CPT, when a physician or other qualified health care professional (QHP) covers for another, the patients are considered either new or established based on their relationship to the physician for whom coverage is provided.
PREVENTIVE VISIT FOR PATIENT WHO HAS ALREADY HAD A WELL-WOMAN EXAM
Our physicians occasionally provide a preventive medicine visit to a woman who has already received a well-woman examination from a gynecologist, and our claim for service is denied. How can we resolve this?
This shouldn't occur because the taxonomy numbers of the physicians providing the two services should alert the payer to the different focus of each service. But since it is happening, an appeal may be your best approach to the denials. Some payers routinely deny the second preventive service within a year but reverse the denial when it's appealed. An appeal is an unfortunate administrative burden, but worthwhile given the value of preventive care.
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