# New Patient Vs Established-old patient had arrived



## buuvaneisswaran (Sep 30, 2012)

A 7 Yrs old patient had arrived to a hospital for DtaP Immunization and only injection administration was billed.Then after 2 Yrs he arrives to same group but different physician for an Injury and Detailed EM has been performed.Please let me know whether the patient is New or Established Patient.Thanx in advance.


----------



## arunna26 (Sep 30, 2012)

Hi ,

The patient is an established patient pnly.As patient had returned back to facility before 3 years, and even though different physician sees him now, the physician belongs to same group only.

The patient is an established patient to the facility


----------



## nutter98 (Oct 1, 2012)

I work for a multi-specialty group and even though a patient is established with one physcian in the group that doesn't make him established in the whole group.  An example:  a patient comes in and is seen by a primary care doctor for a routine physical.  It is discovered that the patient has a rash and is referred to the dermatologist within the same group practice.  The dermatologist can bill this patient as a new patient if the dermatologist has never seen the patient before.  I hope this helps.


----------



## rthames052006 (Oct 1, 2012)

nutter98 said:


> I work for a multi-specialty group and even though a patient is established with one physcian in the group that doesn't make him established in the whole group.  An example:  a patient comes in and is seen by a primary care doctor for a routine physical.  It is discovered that the patient has a rash and is referred to the dermatologist within the same group practice.  The dermatologist can bill this patient as a new patient if the dermatologist has never seen the patient before.  I hope this helps.




To be a bit clearer on the above scenario....

 The guidelines state:

A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice within the past three years.  

The key is the subspecialty here.

Hope this makes it a bit clearer for those who may not know the rules.


----------



## LLovett (Oct 1, 2012)

*Did the provider see the patient whent they got the shot?*

If the provider did not see the patient, i.e. no face to face encounter, then the patient is new.

Laura, CPC, CPMA, CEMC


----------



## buuvaneisswaran (Oct 1, 2012)

Yes,but the patient had only received Injection Admin here and i dont know does it makes him Established patient.My confusion is that,"An established patient doesn't require any E/M records backup in the Group"?? or this isnt an requirement criteria for New and Established patient Rules.Thank U


----------



## Naveen Rachagolla (Oct 2, 2012)

*New $ Established*

I agree with Nutter and Rthames, In CPT book page # 5 there is a decision tree for new vs Established patients whcich gives clean picture about New and Established patients.


----------

