Wiki New Patient vs Established Pt Question

[llewellyn]

We have a new provider to our practice who is bringing established patients with her . The question is even though we have not seen the patient before the patients have seen this provider within the last three years would you code this as a new or established patient for their first visit within our organization ?

 

[solocoder]

We had the same situation here a few years ago. They had to be billed as established patients. A few times we did not know they had seen the doctor in his previous practice, billed them as new and the claims denied.

 

[danskangel313]

If that specific provider sees the patient first, it's established. But, in an unlikely scenario, if another provider in the office sees the patient first, then it's a new patient.