Wiki New vs Established E/M and Patients Following Physicians to New Business Location

[charlene55]

Our question is regarding the E/M codes 99201-99215, Preventive 99381-99397, and assignment of New versus Established patient; specifically for patients following a physician from one local private practice to another local FQHC Clinic within the 3yr period (same rendering physician NPI# but different Business Group Tax ID numbers). Would these patients be considered "new" or "established" ?

As a Federally Qualified Health Center the mass majority of our patients are Medicare and/or Medicaid; and need supporting documentation from CMS.

Any help on this question is greatly appreciated.

Charlene
cdigiacomo@opendoorhealth.com

 

[CodingKing]

Same physician last 3 years is established regardless of group practice. CMS follows CPT guidelines. For example from Noridian


https://med.noridianmedicare.com/web/jeb/specialties/em/new-vs-established-patient

If a patient was seen by a physician in a clinic and sometime during the 3-year period was seen again by that same physician at the same clinic, at another clinic, or in this physician's private practice, this is still an established patient situation. If this patient sees another physician of the same specialty and subspecialty at a location where the first physician also practices, this is also an established patient situation.

Group practice only comes into play when its different physician. If you look at CPT its 2 distinct statements

Established Patient:

1) An individual who received professional services from thephysician/NPP

2) or another physician of the same specialty who belongs to the samegroup practice within the previous 3 years.