EM Coding Alert

Question: I work in a family practice office, and we will be having a new physician join our clinic next year. This physician is coming from a different area/location. Assuming patients from this physician’s previous clinic transfer to our clinic to continue their care, will these patients be considered new or established? The physician will have a new tax ID number and would have never seen these patients before in our clinic.

Texas Subscriber

Answer: You would consider the new physician’s patients established.

You may have heard of the three-year rule when distinguishing between established and new patients. CPT^® 2017 defines an established patient as one who has received professional (face-to-face) services from the physician/qualified healthcare professional or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 36 months (three years).

If the provider treats a patient during a face-to-face service within the previous three years (in any location), that patient is established (in all locations). Where the patient is seen doesn’t matter. This includes patients who are first seen in the hospital. When arriving to the office, they are also established patients. Also, because the patient is considered established to your new physician, that patient is considered established to all the physicians in his new practice who are of the same specialty and subspecialty.