General Surgery Coding Alert

Question: When a physician joins a new practice and sees patients from the former practice within three years of the previous visit, should you code the E/M encounter as new or established?

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Answer: Whether the physician joins a new group practice or begins their own practice, the answer remains the same. The physician should code according to the time frame with which they last saw the patient. So, if you saw a patient two years prior, and the next visit takes place at a new practice, you should still code the patient as if they are an established patient.

Rule of thumb: Generally, you should consider a patient to be established if any physician in your group (or, more precisely, any physician of the same specialty billing under the same group number) has seen that patient for a face-to-face service within the past 36 months. Encounter location doesn’t factor in to the new versus established debate.