Wiki new pt visit coding

[Lisa Heikes]

I work with a multi speciality practice and we have several Orthopedic physicians and are having discussions about when a patient is considered new. For instance if a patient is seen by Dr. A for dx- fractured arm and then 2 years later is seen by Dr. B for dx-fracture leg. Is the visit to Dr. B considered established visit because the physicians work under the same tax identification. Does diagnosis have any role? If anyone knows where I could find documentation to support this I would be really grateful. THANKS

 

[RebeccaWoodward*]

Diagnosis has no role. Dr. B would charge an established visit since the patient was seen within the last 3 years, same specialty.

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.

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

Page 47

 

[medcoder9]

He is an established patient. In my AMA standard CPT 2010 there is like a flowchart titled "Decision tree for new vs established patient". It is on page 2.