CLIP & SAVE:
Here's the Quick Way to Find Out if the Patient Is Really New
Published on Thu Jan 04, 2007
Take the AMA's advice and answer these five questions to determine definitively if you should treat a patient as new or established for coding purposes. 1. Has the patient ever received any professional services from any physician in this group?
Yes: go on to question 2
No: The patient is New 2. Has the patient received any professional service from a particular physician within the past three years, who is now reporting service?
Yes: The patient is Established
No: Go on to question 3 3. Has the patient received any professional service* from a physician in the group of the same specialty within the past three years?
Yes: Go on to question 4
No: The patient is New 4. Has the patient received care from a physician of the exact same specialty within the past three years, or is a physician of a different subspecialty now providing care?
The providing physician is of the same specialty: The patient is established
The providing physician is of a different sub-specialty: Go on to question 5 5. Does the current providing physician have the same tax ID as the physician who provided a separate service within the past 36 months?
Yes: The patient is Established
No: The patient is New * CPT defines a professional service as -those face-to-face services rendered by a physician and reported by a specific CPT code.- Note: You can find the AMA's -new vs. established- flowchart on p. 2 of the -Professional Edition- of the 2007 CPT Manual, published by the AMA.