My provider sees a patient that lives here and in another state. The patient had an excision in Dec 2022 in the other state but was here at the time his sutures needed removed so we removed them; did not bill him or his insurance anything. Now he is here for an office visit. E/M guidelines state "professional services" are face to face services, so even if we didn't bill anything out for the Dec 2022 visit, since the provider saw him and took out the sutures, would he be considered established? His first visit with us was 08/31/2020 for an office visit, 12/06/2022 for suture removal only and now today 09/10/2024 for office visit. Any help is appreciated, thanks!
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Wiki New or established patient?
- Thread starter WHAUN
- Start date
LGillstrom
Contributor
Technically, the patient is not a new patient as you previously saw them within three years. Unbillable or unbilled services that are still face-to-face count toward being new vs. established. It is unfortunate that your provider did not report the suture removal, as it was a billable service for your clinician if they weren't the provider who put in the sutures! But to answer your question, yes, your patient is established (assuming that this is the same provider or same group practice as who removed the sutures).