Use This Simple Tool to Determine Whether the Patient Is Really New
Published on Thu Mar 01, 2007
Answer the new-vs.-established question correctly every time Take the AMA'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. 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. 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 a professional service 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 specialty: The patient is established.
The providing physician is of a different subspecialty: Go to question 5.
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. Editor's note: You can also find a similar flowchart on page 2 of the -Evaluation and Management (E/M) Services Guidelines- portion of CPT 2007: Professional Edition, published by the AMA.
