Billing for an old new patient.

[jenburton1981]

Can anyone tell me what the timeline is for billing for an old new patient? For example I thought it was they had to not have been seen in the past 4 years. Is this correct? If not what is the proper time line? Thanks!

 

[mywiles]

It's 3 years. Per the Medicare Claims Processing Manual, Chapter 12, Section 30.6.7.A:

30.6.7 - Payment for Office/Outpatient Visits (Codes 99201 99215)

A. Definition of New Patient for Selection of Visit Code

Carriers must interpret the phrase “new patient” to mean a patient who has not received any professional services from the physician or physician group practice within the previous three years. "

 

[cpccaperton]

In the E/M Services Guidelines section of your CPT manual, CPT defines established patient as "...one who 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." So, on the flip side, a new patient would be anyone outside the three year threshold. This gives you an official source for any that aren't Medicare.