Ophthalmology and Optometry Coding Alert

Answer the new-vs.-established question correctly every time with this tool

Take the American Medical Association'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?

No: The patient is new.     Yes: Go on to question # 2.
 
2.  Within the past three years, has the patient received any professional service from a particular physician, who is now reporting a 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? (CPT defines professional services as those face-to-face services rendered by a physician and reported by a specific CPT code.)

No: The patient is new.     Yes: Go on to question #4.
 
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 speciality: The patient is "established."                                  

The providing phsician is of a different subspecialty: Go on to question #5.

 
5. Does the current providing physician have the same tax I.D. as the physician who provided a separate service with in the past 36 months?

Yes: The patient is established.    No: The patient is new.
 
Note: You can also find a similar flow chart on page 2 of the Evaluation and Management (E/M) Services Guidelines portion of the CPT 2007: Professional Edition, published by the AMA.