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New patient or not???

Herbie Lorona

Expert
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409
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Yuma
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When one of your providers is covering for another Dr (not part of same group) I know that the visit is not considered a new patient. What happens if the patient comes back a few months later to become a new patient of the practice and is scheduled with another one of the providers? Is that visit considered established since the patient has seen one of our providers before or is it a new visit since the first time they were covering for another physician?
 

rthames052006

True Blue
Local Chapter Officer
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1,905
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York, Pa
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When one of your providers is covering for another Dr (not part of same group) I know that the visit is not considered a new patient. What happens if the patient comes back a few months later to become a new patient of the practice and is scheduled with another one of the providers? Is that visit considered established since the patient has seen one of our providers before or is it a new visit since the first time they were covering for another physician?
It depends, if the provider is of a different sub specialty it could be a new patient. That would be the exception. Check your cpt book for the coding tip in the beginning of the e/m section.

Here's what it states in the CPT 2012 Professional Edition:

Determination of Patient Status New or Established Patient

Soley for the purposes of distinguishing between new and established patients, professional services are those face to face services rendered by a physician and reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the exact same speciality and subspecialty who belongs to the same group practice, within the past three years.
 
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