Wiki New pt vs Est

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nc_coder

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A pt comes in only to have a flu shot the first time they are in our office. She then comes back several months later for an OV. Since we have already sent a claim from our office for the flu shot, would the OV then be a new pt or established? There is a little controversy going on in our office about this.
 
This would be an established patient.

The following is copied from another new patient vs. established post and I think it's very helpful:

"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 ) from the physician or physician group practice (same physician specialty) within the previous 3 years."
 
This is the answer I got when I posted the same question on the AHIMA website. :confused: I tend to agree with the responses I received here on the AAPC threads, but the AHIMA response reopens the question.


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.


The patient is still new if no seprately reportable E&M service was performed.
 
nc_coder said:
This is the answer I got when I posted the same question on the AHIMA website. :confused: I tend to agree with the responses I received here on the AAPC threads, but the AHIMA response reopens the question.


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.


The patient is still new if no seprately reportable E&M service was performed.
Click to expand...

If no professional services (face-to-face) were provided by the MD w/ in the last 3 years, this would be a new pt. Patient's can go to their local pharmacy and receive the flu shot. It would be no different if the patient went to an urgent care practice (i.e. example) and received the flu shot. Many of these type of practices submit roster billing for this type of service.

Page 50...

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
 
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RebeccaWoodward* said:
If no professional services (face-to-face) were provided by the MD w/ in the last 3 years, this would be a new pt. Patient's can go to their local pharmacy and receive the flu shot. It would be no different if the patient went to an urgent care practice (i.e. example) and received the flu shot. Many of these type of practices submit roster billing for this type of service.

Page 50...

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
Click to expand...

Ok. I understand what you are saying, but if a patient were to have gone to a pharmacy or urgent care, then this would have been a separate TIN and NPI. Would this not make a difference?
 
nc_coder said:
Ok. I understand what you are saying, but if a patient were to have gone to a pharmacy or urgent care, then this would have been a separate TIN and NPI. Would this not make a difference?
Click to expand...

True...different TIN/NPI. However, what determines the status of the patient (in this case) is whether or not the patient had any face-to-face, professional services, w/in the last 3 years with the provider.

"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."

Administering the flu shot falls within this guideline. Requesting a flu shot and nothing else does not require professional services from a provider. Administering the flu vaccination does not require a physicians order or supervision...
 
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