Wiki New patient E&M when insurance carrier changes

[NEOSM507]

Hello,

I recently had a conversation with a provider who stated that a patient is considered NEW (for coding purposes) when they have been treating under workers comp and then come in to treat for a separate, unrelated visit under their private insurance in under 3 years. (or vice versa). Coding a new patient visit has nothing to do with carrier, correct?

Thank you

 

[CodingKing]

Correct. Established patient is one that was seen in the last 3 years. it doesn't matter even if they were self pay previously. I know some workers comp can have different rules, like new injury = new patient, but that is only the case when billing workers comp.