Wiki New Patient-3 Year Rule

[casey3266]

Hello all!!

Hoping to get some clarification from you all in regards to a New Patient who has not being seen by our practice for over a three year period. We had a patient in our practice recently who we have not seen nor prescribed meds for in over a three year period. However, we do have Telephone Encounters recorded in our system. They are mostly in regards to why the patient was not able to make it in for the appointment, etc. I was wondering if you could tell me if we would still need to consider the patient established due to the telephone encounters or if we can bill as a new patient?

Thank you so much in advance for your assistance with this issue.

Casey Jablonski

 

[dclark7]

Both CPT and CMS describe a new patient as one who has not received any professional services from the physician ...........within the past three years. CPT also describes professional services as "face-to-face" with the physician or NPP.

So to answer your question if the patient has not had any face-to-face services with your providers, then the patient can be considered a new patient according to the definition. The CPT book has the definition of professional service (I have the CPT Professional Edition) and both CPT and the CMS E/M Services Guide have the definition of a new patient.

 

[casey3266]

Thank you Doreen. Our confusion lied on what qualified as "professional services" in this instance since the provider did speak with the patient about the importance of why they need to be seen in attempts to encourage them to make an appointment. We are a Nephrology practice who have patients who state that they "feel fine" and don't understand the issues that are going on with their kidneys despite them "feeling fine".