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By definition of the unscheduled nature of ED visits, a very high % of ED visits are new problem to examiner, also an entirely new record is created for each visit. But you have to be a bit careful to assume it's always the case. Patients do return for follow up visits sometimes, and there are frequent fliers who came back day after day with similar problems or seeking drugs. But even then it could be a new problem to the particular provider. There are no "Established" ED patients by CPT definition. But that's a separate issue!
I think that's pushing it a bit. But the argument is made that there are no Established patients and a new record and work up are required. But I'd draw the line on a planned follow up for an injury or someone returning later with exactly the same problem. Just my view.