Wiki new vs established

[deon lartigue]

True definition of "new patient" ? Example: doc sees pt 1-5-11 at one location, 6 mos later leaves this practice and joins new practice in different state (& now practicing under completely new Tax ID #), sees same patient again after joining this new practice 6/10/11). Would doc bill as a new pt or established pt visit? And why? Thanks!

 

[RebeccaWoodward*]

Definition of New Patient for Selection of E/M Visit Code

Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

30.6.7

http://www.cms.gov/manuals/downloads/clm104c12.pdf


When you change practices

Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that's passed since your last encounter with the patient is the determining factor.

http://www.aafp.org/fpm/2003/0900/p33.html

 

[deon lartigue]

Thanks Rebecca! Regardless of the documented evidence we supply to the physicians to explain this scenario, it seems it's still unclear and the discussions go on, and on, and on.........intermittently. It's nice to have expert facts and opinions to back up our own. D