Wiki New or established patient?

[metzger130]

Patient comes in for Mammograms only for years as they are seeing someone else, but comes to office for Mammograms. The patient then decides to become a patient and schedules and appointment. Is this a new patient or established? I can see both sides of the coin as they have been "seen" in the past 3 years, but she has never actually seen a physician, just billed under whomever reads the mammogram.
Thank you,
Rob

 

[kostecki]

They would be new since there was no prior face to face visit:

Pub. 100-04, Medicare Claims Processing Manual, chapter 12, section 30.6.7 provides that "Medicare interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years. For example, if a professional component of a previous procedure is billed in a three year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit."