Wiki New or Established patient?

[Lorisvg]

I am not sure if this patient is new or established. My family practice doctor did a colonoscopy at the surgery center for a patient he had never seen. I billed the colonoscopy with the pos as the surgery center. The patient then came to the office as a new patient for a physical. Is he a new patient as the previous charges weren't e/m, or is he established?

Thanks for any help you can give me!

 

[rmarkowitz]

As long as the colonoscopy was performed by the provider within the last 3 years, then this patient would be considered an established patient.

For reference: https://www.aapc.com/blog/37138-how-to-determine-new-vs-established-patient-status/

New Patient - A new patient is defined as one who has not received any professional services from a physician or physician group practice (same
physician specialty) within the previous 3 years, e.g., evaluation and managment (E/M) services, surgical procedures or other face-to-face services.
- Physicians in the same group practice of the same specialty are to bill and be paid as though they were a single physician.
- Physicians who are of a different specialty may bill and be paid without regard to their membership in a group.

• Established Patient - An established patient is one who has received professional services from a physician or a physician in the same group
practice of the same specialty within the previous 3 years.
- If a physician is on call or covering for another physician, a patient’s encounter will be handled the same as if the unavailable physician were there.
- Physicians who share the same tax ID are part of the same group even if they are in different locations

I hope that this helps.

 

[Lorisvg]

Sure does, Thanks!