Neurology & Pain Management Coding Alert

Ask yourself 5 easy questions to pinpoint the answer If your coders have trouble distinguishing whether a patient is new to your practice, help is here. Take the AMA's advice and answer these five questions to determine definitively whether you should treat a patient as new or established for coding purposes. Question 1: Has the patient ever received any professional services from any physician in this group? Yes: Go on to Question 2. No: The patient is New. Question 2: Has the patient received any professional service* from a particular physician within the past three years, who is now reporting service? Yes: The patient is Established. No: Go on to Question 3. Question 3: Has the patient received any professional service* from a physician in the group of the same specialty within the past three years? Yes: Go on to Question 4. No: The patient is New. Question 4: Has the patient received care from a physician of the exact same specialty within the past three years, or is a physician of a different subspecialty now providing care? The providing physician is of the same specialty: The patient is Established. The providing physician is of a different subspecialty: Go on to Question 5. Question 5: Does the current providing physician have the same tax ID as the physician who provided a separate service within the past 36 months? Yes: The patient is Established. No: The patient is New. * CPT defines professional services as "those face-to-face services rendered by a physician and reported by a specific CPT code." More information: You can find the AMA's "New vs. Established" flowchart on page 2 of the "Professional Edition" of the 2007 CPT Manual, published by the AMA.