Pediatric Coding Alert

Reader Questions:

Clarify 'New' Versus 'Established' Patient

Question: Our practice performed a test on a patient another doctor referred to us. Our physician was not present for the procedure; a technician administered the test. Should I consider this patient an established patient when she returns for additional care?Mississippi SubscriberAnswer: No, you should consider the patient "new" until a face-to-face encounter with your physician occurs. If the primary physician (or another physician billing under the same group number) provided a non-face-to-face service for a patient and then provided a face-to-face service within three years, you should still consider the patient to be "new" when selecting an E/M service code for the face-to-face service.According to AMA guidelines, there are additional factors to consider as well:The three-year rule is a well-established rule for "new" versus "established" patients. That is, if any physician within a given practice has a face-to-face visit with a patient within a 36-month period, that patient is [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Pediatric Coding Alert

View All