Neurology & Pain Management Coding Alert

If your coders have trouble distinguishing whether a patient is new to your practice, help is here. Take the AMA's advice and answer these five questions to determine definitively whether you should treat a patient as new or established for coding purposes.

Question 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.

Question 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.

Question 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.

Question 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 subspecialty: Go on to Question 5.

Question 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 professional services as "those face-to-face services rendered by a physician and reported by a specific CPT code."

More information: You can find the AMA's "New vs. Established" flowchart on page 2 of the "Professional Edition" of the 2007 CPT Manual, published by the AMA.