# New patient Vs Established



## tammyj0212 (Oct 24, 2013)

Please help! 

If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.


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## suemt (Oct 25, 2013)

Has the patient been seen by the practice or the physician within the past 3 years?  That is the distinction between new and established.


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## tammyj0212 (Oct 25, 2013)

It is a new patient but there is no HPI so how would you code a new patient?


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## mlbaker1974 (Nov 2, 2013)

In order to bill a new patient visit all 3 of the key components must be met and the patient cannot have seen any provider in this practice within the past 3 years.  You may not downcode to an established patient encounter, that is purposefully misrepresenting what happened in the encounter.


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## LGillstrom (Nov 5, 2013)

tammyj0212 said:


> Please help!
> 
> If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.



 You should never "downcode" from a new patient visit to an established patient visit when a patient is, indeed, a new patient.

In the scenario you presented, I would recommend querying the provider, and asking them to provide additional documentation. The service, if not meeting the "three of three" criteria for a new patient visit is not reportable.


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## Tonyj (Nov 6, 2013)

tammyj0212 said:


> Please help!
> 
> If a patient comes in for a consult before a procedure and there are no presenting problems meaning there is no HPI can I downcode the visit from a new patient visit to a established visit? Just wondering because I know you need all 3 elements to code a new patient code.



The consult is for what procedure? Wouldn't he/she asses the patient before the procedure?


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## Saedron (Nov 10, 2013)

Correct me if I'm wrong, but in the absence of HPI the provider CAN comment on 3 chronic conditions to qualify the HPI portion of the E/M.


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