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Neurology & Pain Management Coding Alert

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How Is Established Defined?

Published on Sat Mar 01, 2003

Test your your coding knowledge.Determine how you would code this situation before looking at the box below for the answer.
Question: What is the definition of "established patient" when assigning E/M codes? If we haven't seen a patient in five years, is he or she "established?" Oklahoma Subscriber


Answer: According to CPT E/M guidelines, an established patient "has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." Therefore, if the physician has not seen a patient for five years, the patient is considered "new" rather than established.  
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