Remember to Consider Face-to-Face Services for New/Established Patient Status
Question: A patient came into our pulmonology practice for a pulmonary function test (PFT) in July 2025. A provider in the practice did not see the patient but did read the PFT. In December 2025, the same patient came in and saw a different pulmonologist in the practice. Would the patient be considered a new or established patient for the December 2025 visit? Missouri Subscriber Answer: If the first provider only read/interpreted the PFT results and didn’t see the patient face-to-face, then the patient is considered a new patient for the December 2025 visit. According to the CPT® guidelines for evaluation and management (E/M) visits, professional services are face-to-face services rendered by a physician or other qualified healthcare professional. “A new patient is one who has not received any professional services” from the reporting qualified healthcare professional or another qualified healthcare professional in the same specialty and subspecialty “who belongs to the same group practice, within the past three years.” This means that if the patient presented for the PFT in July 2025 and saw a pulmonologist for a face-to-face E/M visit (for example, to discuss the results, establish a treatment plan), then they would be considered an established patient for the December visit even though another pulmonologist in the same practice would see the patient for a face-to-face visit. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
