CLIP & SAVE ~ Here's the Quick Way to Find Out if the Patient Is New
Published on Fri Nov 17, 2006
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.