Wiki New v.s. Established

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Jannie53

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When an established physician joins a new practice (changes TIN) when he sees a patient from his old practice is that New or Established? We are having a discussion and I will need reference material. I believe that in 2007 this was changed so that the appropriate billing today would be an established patient as they are 'known' to the physician.
 
We consider them as established. I have not found anything regarding this anywhere to clarify this, but the way our company looks it is the patients information was available to the provider and is not new. Taking the information and transferring it a new practice is merely administrative and not really a justification of the components of the visit and not really meet medically necessity. If additional components(lets say additional history) are given, then it would be factored in the code for the established patient.

I hope this makes sense. :)
 
proof can be found in wpsmedicare or cms.hhs.gov and also int he E/M section of the CPT manual.

A patient is considered est after having a "face to face" encounter with a provider. If a provider joins a group of providers and his old patients come to see him at his new location they are established to HIM even though it is a new office location/address. Keep in mind that your providers personal NPI did not change when he joined a new practice.
 
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