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Primary Care Coding Alert

Reader Question:

New Versus Established Patient

Published on Thu Nov 01, 2001

Question: One of our patients was seen by a physician who had seen her two years ago at a different practice. Should I bill this encounter as a new patient visit (e.g., 99203) or as an established patient visit (e.g.,99213)? Ive been told that, because she was seenelsewhere, we can bill a new patient encounter.
                                                         
Kansas Subscriber  
Answer: No, you should not bill this as a new patient visit. According to CPT E/M service guidelines, a new patient is an individual who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. Using this definition, the patient has indeed received services from the physician within the previous three years (albeit at a different practice) and should be considered an established patient.
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