jessrenee
New
If a patient is seen 3 years apart to the day, are they New or Established? For example patient seen on 6/05/2012 and now being seen 6/05/2015.Edit/Delete Message
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Wiki New VS. Establsihed cut off
- Thread starter jessrenee
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If a patient is seen 3 years apart to the day, are they New or Established? For example patient seen on 6/05/2012 and now being seen 6/05/2015.Edit/Delete Message
ashley.roberts@nchmd.org
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New Vs Est
I would try to bill as a new patient because if you use a date to date calculator the time frame between those two dates (including the end date) is 3 years and 1 day.
This is per CMS:
"Q. What constitutes a new versus an established patient? Can a provider bill an office/outpatient new patient visit code and/or an initial hospital care service code for a patient seen within the past three years but for a new problem?
A. The rules with respect to new and established patient office visits are unchanged. Providers should follow the guidance in Publication 100-04, Chapter 12, Section 30.6.7 of the Medicare Claims Processing Manual:
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."
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/se1010.pdf
I would try to bill as a new patient because if you use a date to date calculator the time frame between those two dates (including the end date) is 3 years and 1 day.
This is per CMS:
"Q. What constitutes a new versus an established patient? Can a provider bill an office/outpatient new patient visit code and/or an initial hospital care service code for a patient seen within the past three years but for a new problem?
A. The rules with respect to new and established patient office visits are unchanged. Providers should follow the guidance in Publication 100-04, Chapter 12, Section 30.6.7 of the Medicare Claims Processing Manual:
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."
http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/se1010.pdf
Last edited:
JEYCPC
Expert
CPT also says the same....within the past three years.