Practitioner Determines New or Established, Not Location
Question: If our pediatrician discharged a newborn from the hospital and then sees the same baby 12 days later at our practice for their first preventive medicine service, would the baby be classified as a new patient or an established one? Wisconsin Subscriber Answer: This baby would be considered an established patient because they have already received professional, face-to-face services from your pediatrician within the past three years, and those services have presumably been services reported by a specific CPT® code(s). Because of these factors, the child is regarded as established to your practice even though this is the child’s first encounter in your physical office. For this visit, you should choose 99391 (Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/ anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)). Remember, the deciding factor here between whether the patient is new or established is the pediatrician seeing the same patient twice in a three-year period — not the change in venue. Unless your clinicians are acting in the capacity of different subspecialties when treating the patient, the very first service rendered effectively establishes the patient with your practice; the place of service (POS) is not the factor to focus on. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
