Could someone please clearify the E/M guidelines where if a patient comes in a is seen by a nurse for a flu shot but no E/M service was preformed would that be considered a new patient or when the patient comes in 2 months later for a well man/woman check and that is the first E/M office visit, will that be considered the new patient visit. I understand the guideline states: A new patient is one who has not received any professional service from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years. Do that include Nurse visits also. I have a patient that can in one month for a immunization and the next month for a blood pressure check, than came in for the first office E/M visit.