General Surgery Coding Alert

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.