See how changes affect your use of 99201-99205, 99460-99461, and more. Coding guidelines can sometimes seem confusing when you're trying to decide whether to classify a patient as new or established. For example, when an established patient presents to your practice to see a new physician, should you report a new patient office visit code? CPT® 2012 attempts to clarify this question and one other E/M stumper: Who counts as a "qualified healthcare professional" to administer that vaccine or provide prolonged service? 'New Patient' Classification Goes to a New Level Currently, CPT® indicates that a "new patient" refers to a patient who has not received any professional services, such as an E/M or other face-to-face service, from the physician or another physician of the same specialty in the same group practice within the past three years. Clarification: What it means: "We'll have to wait and see if this will make a difference in how our local Medicare carriers handle new patient claims," says Linda Vargas, CPC, CEMC, coding and reimbursement specialist with Cass Regional Medical Center in Harrisonville, Mo. "Medicare has generally followed the same CPT® rules, but further defined it by saying that providers with the same tax ID and same specialty are the same provider in their eyes, regardless of location." RN Doesn't Fit 'Other Qualified Healthcare Professional' If your payer follows CPT® rules, you can now exclude registered nurses from the list of professionals who can administer vaccinations or provide prolonged services for patients. At the request of many physicians, CPT® 2012 now defines the term "other qualified healthcare professional." Although this definition didn't make it into the 2012 manual, the AMA lists it as part of the "CPT® 2012 Errata" on its Web site (www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf). The definition is as follows: "A 'physician or other qualified health care professional' is an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service. These professionals are distinct from 'clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service, but who does not individually report that professional service. Other policies may also affect who may report specified services." Result: Example: Bright side: