Pediatric Coding Alert

Question: If a pediatrician closes his solo practice and joins a group practice with a different tax ID, are visits with patients from his previous practice new patient visits or established patient visits? What if a different pediatrician in the group practice saw the patient before the former pediatrician?

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  Answer: According to CPT Codes , a new patient 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. Therefore, any patients from the pediatricians former solo practice would be coded as established if he or she has seen that patient within the three-year limit. An established patient of the pediatrician new to the practice is also established to other pediatricians in the practice with the same tax ID number, regardless of who sees the patient first.