CLIP & SAVE:
Here's the Quick Way to Find Out if the Patient Is New
Published on Tue Jan 02, 2007
Answer the new-or-established question correctly every time with this tool
Take the AMA'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. Within the past three years, has the patient received any professional service from a particular physician, who is now reporting a 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 the same specialty, within the past three years? (CPT defines professional services 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 ID as the physician who provided a separate service with in the past 36 months?
Yes: The patient is established. No: The patient is new.
Note: You can also find a similar flow chart on page 2 of the Evaluation and Management (E/M) Services Guidelines portion of CPT 2007: Professional Edition, published by the AMA.