Eli's Rehab Report

Question: I work for a doctor who just left a large group practice to start his own practice. Some patients followed him from the old practice to the new. Should they be considered new patients or established patients?

Billing Supervisor in Newark, N.J.

Answer: CPT 2000 describes a new patient as 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. This rule holds true regardless of any billing arrangements. Therefore, if the physician saw the patient at his previous practice within the past three years, that patient should be billed as an established patient. The intent of the higher reimbursement for new patients is due to the fact that the physician lacks clinical knowledge of the patient, and, consequently, extra work and decision-making will be involved with his or her assessment of the patient.