Part B Insider (Multispecialty) Coding Alert

Published on Sun Nov 05, 2006 PDF

These 5 questions pinpoint patient's status Take the American Medical Association's advice and answer these five questions to determine definitively if you should treat a patient as new or established for coding purposes.
 
1. Has the patient ever received any professional services from any physician in this group?

No: The patient is new.  Yes: Go on to question # 2.
 
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.
 
3. Has the patient received any professional service* from a physician in the group of same specialty, within the past three years? (* CPT defines a professional service as, those face-to-face services rendered by a physician and reported by a specific CPT code.-)

No: The patient is new.  Yes: Go on to question #4.
 
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.
 
5. Does the current providing physician have the same tax I.D. as the physician who provided a separate service with in the past 36 months?

Yes: The patient is established. No: The patient is new.
 
Editor's note: You can also find a similar flow chart on p. 2 of the Evaluation and Management (E/M) Services Guidelines portion of the CPT 2007: Professional Edition, published by the AMA.