Wiki New E/M after surgery by another MD

[tlstaz6543]

We are a large multispecialty surgical group. One of our surgeons performed surgery on a patient months ago....all that was charged was the surgery, no E/M code was billed at that time. Now, we have the patient returning to the office to see another of our surgeons with a different diagnosis. I was once told, long time ago, that as long as the patient has never been billed for an E/M code, they can still be new once they come to the office. Is this true or has it changed? I can't find anything specifically on this matter.

Thanks for your time in reading!

 

[emcee101]

I'm not sure if it was ever different, but the rule for a new vs. established patient for as long as I have been coding has been (as defined by CPT):

"A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years."

So if the doctor who did the surgery is of the same specialty as the doctor who is seeing the patient afterwards, then that patient has already received professional services and therefore would be an established patient.

You can also reference the new vs. establsihed decision tree that is located in the E/M section of your CPT book.