Wiki New Patient Requirements

[cmblocher]

I am having a blank, can someone please help! Where can I find the New Patient office requirements. I know this information is listed in our CPT book, but wanted to know if they also had it posted on CMS's website.

Thanks

 

[RebeccaWoodward*]

A Definition of New Patient for Selection of E/M Visit Code

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 3 years. For example, if a professional component of a previous procedure is billed in a 3 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. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.7