Wiki New vs Est patient

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tweener12

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Hello all! I know this subject has been beaten to death, however, I need clarification on one question. I have a cardiologist that left a cardiology group in 2022 to start his own practice. Would the patients that chose to follow him to his new practice still fall under the 3-year established patient criteria? I understand the rule of new / established but wasn't sure if that applied to "switching" of practices as well. I'm new at the E/M coding and want to make sure I'm giving correct information.

thanks!!!
 
Hi there, that's correct. The patients who follow are established.
 
jkyles said:
Hi there, that's correct. The patients who follow are established.
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yeah, the more I thought about it, the more it made sense. What about a patient that transfers from the "old" practice to his new practice, but has never been seen by him? They would be a new patient, correct?
 
tweener12 said:
yeah, the more I thought about it, the more it made sense. What about a patient that transfers from the "old" practice to his new practice, but has never been seen by him? They would be a new patient, correct?
Click to expand...

I actually just read an answer to this on NGS Medicare recently:
Drs. A and B were both members of a same-specialty practice that closed, and now both physicians join a new same-specialty practice with a new NPI. Patient Jones saw Dr. A at the original practice and, within a three year period of seeing Dr. A, now sees Dr. B during a first visit to the new practice.
Please clarify whether Patient Jones is considered a new patient to the new practice and to Dr. B., since Dr. B was formerly in a same-specialty group with Dr. A.
Answer: Dr. A and Dr. B are now members of a new practice, and their prior relationship as colleagues in the former practice is no longer in effect. If the patient sees Dr.B in the new practice, the patient is considered new to the practice and to Dr. B, who has not personally seen the patient before. If the patient had seen Dr.A in the new practice, the patient would have been considered established to Dr. A, who had personally seen the patient within the prior three years.
 
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