How does Emergency Medicine fit in with the new vs established patient rules? Many times providers in the ER or Walk-In depts are Internal Medicine or Family Practice providers but their speciality is Emergency Medicine. What if a patient went to the ER and saw an Emergency Medicine provider that is board certified in Internal Medicine and then needed to follow up with a primary care provider. The patient doesn't have a primary care provider so he is seen by a Physician Assistant who works in the Internal Medicine department at the same facility as the ER. Would the visit with the PA be established or new?