New Patient vs Established patient

jmfarrer

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Could someone please advise where I would locate the information stating how long between visits an established patient would be considered new patient status?
 

Jennifer Turner

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Local Chapter Officer
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The short answer is 3 years. A more elaborative answer is that if the pt. has not received any professional service from the physician or another physician in a group of the same specialty within the last three years then they are considered a new pt. Please refer to your CPT book page 4 of the E/M service guidelines.

Hope this helps!
 

msmia

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Could someone please advise where I would locate the information stating how long between visits an established patient would be considered new patient status?

There is a very helpful decision tree in the front of the CPT book, page 5 of the E/M section to be accurate
 

duboses

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New and Established Patient

In the 2016 CPT professional edition book published by the AMA, the information is found on page 4. This is at the beginning of the Evaluation and Management section. In my 2016 CPT book published by AAPC, the information is found beginning on page 131 in the E/M coding advice section.​
 
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