I think using the words new/established can be confusing because those are the words used to describe the patient in relation to the provider they are seeing. This wording does not relate to COPA.
Using the words "problem, illness, injury and acute or chronic" is better when referring to COPA. As mentioned by
@csperoni, there is no wording when it comes to the Number and Complexity of Problems Addressed which refers to the problems using the words new or established. The only reference to new is when it is an, "1 undiagnosed new problem with uncertain prognosis."
If a patient is a new patient to the provider, it doesn't necessarily mean their presenting problem is. You need to separate the fact that the patient is new/established from trying to determine the COPA. It really doesn't impact the COPA whether they are new or established patient. An established patient can come in to their provider with a problem they have never had diagnosed before, it is dependent upon if it is acute or chronic. However, a new patient "might" have a higher level E/M if there was more workup required, reviewing outside records, consulting with outside providers, ordering more tests, etc.
Read the definitions of the COPA items in the CPT book in the E/M Guidelines in the front. For example, the definition of: Undiagnosed new problem with uncertain prognosis - A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. The key words here are:
high risk of morbidity without treatment. Just as the Noridian quote above states.
It is always going to come back to the documentation. Throw out the fact that the patient is new or established and look at the documentation in relation to the E/M definitions and MDM table (unless you are coding by time of course).
This link gives an example of something that may meet the undiagnosed new problem with uncertain prognosis:
https://www.bcarev.com/2021/04/01/undiagnosed-new-problem/
In relation to your question: "IF the pt has had a condition for years and then is referred to us and its our first time seeing the pt. - is that condition considered established or new?"
The answer is, it depends. If the patient has had a known condition for many years, and they are a new patient, it doesn't mean the diagnosis is an undiagnosed new problem with uncertain prognosis. It could be 1 or more chronic illnesses with exacerbation, 2 or more stable chronic, 1 or more with severe exacerbation, or possibly 1 stable chronic. It depends on the documentation and what is done. Do you have an example we can help you with specifically?
For
example, a patient with Type 1 diabetes moves to a new city, they have had this since birth, they go in for a new patient appointment with a new provider, the condition is being managed by their current CGM and insulin pump, and rx. meds and it is stable. The patient has no other issues. This is not a new problem even though the patient is new to the provider. The provider keeps the patient on the same course and has them f/u in one month. This is a stable, chronic (Low COPA). The provider ordered and reviewed 3 unique labs and reviewed the notes the patient brought from their old provider (Moderate Data), there are prescriptions refilled and managed (Moderate Risk). This would be a new patient Moderate MDM 99204 even though COPA was low.