Anesthesia Coding Alert

Question: In an outpatient setting, what are the criteria for a new versus an established patient?

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Answer: According to CPT, a new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the last three years. An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the last three years.

If a patient changes specialty providers or sees a new physician within a practice, and his presenting problem has no relation to a previous visit, you should treat him as a new patient. For example, Dr. Brown sees a patient for anesthesia services. The patient now sees Dr. Black, a new physician in the practice, for lower back pain. In this case, the patient would be considered a new patient for Dr. Black because the presenting problem (low back pain) is not related to the anesthesia services provided by Dr. Brown.