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Wiki Established Patient Timeframe

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lhoot

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Hello,
We're having a discussion on when the time frame for an established patient expires. If a patient is seen on 10/1/2021 and the last visit prior to this was 10/1/2018, would this patient be an established patient? Would 10/1/21 be the start of year #4 or be the last day of year #3 since the last visit?

Thanks,
Laura
 
The definition for new states no professional services "within the past 3 years". I interpret that as less than 3 years. So exactly 3 years would be new. This is simply my interpretation of this, and I am unaware of any official guidance other than the "within the past 3 years."
Of course, in my many, many, many years of coding, this would impact maybe 4 claims ever.
I personally would bill new, and if the insurance denied, adjust to established.
 
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