Optometry Coding & Billing Alert

Question: Can we report a new patient code if a patient stops seeing one optometrist in our group and begins seeing another optometrist in the same group? CPT says a new patient is one we have not seen in the past three years, but I have also heard that a new patient is one who requires a medical record to be established.

Arkansas Subscriber

Answer: CPT is very clear on this matter: "A new patient (99201-99205) is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.

"An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years."

CPT does not base its new or established patient classification on whether your practice has established a medical record for any particular patient.

The fact that another physician in your practice created a medical record is irrelevant to the type of visit you should report. Because another physician at your practice saw the patient within the last three years, you should report a code from the 99211-99215 series - showing without question that this is an established patient.