# New Patient Definition applies to any POS?



## gaponte (Apr 21, 2009)

Six months ago I red that CMS has clarified the “New Patient Definition”. This new definition states that it does not matter of the POS patient would be considered “established” if he/she was seen in the past three years.

Can some one please tell me which CMS document states this? I already checked the Medicare Claims Processing Manual.


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## RebeccaWoodward* (Apr 21, 2009)

Requires face to face.........

Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., *E/M service or other face-to-face *service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.7


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