Wiki New vs Established 2021

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Can a Nurse Practitioners see New Patient without a physician in the office?

KoBee

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can I get some advice,

If a patient is seeing our specialist and are new to our facility/clinic but they have seen a provider of the same specialty outside at a hospital/or another facility not affiliated with our facility within past 3 years, are they considered new to our facility/clinic?
 

csperoni

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A new patient is one who has not received any professional services (ie, those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services reported by a specific CPT code(s)) from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician/qualified health care professional or another physician/ qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

Unless your provider was previously part of the other group, they are new.

The 2021 E/M changes had nothing to do with definition of new vs established patient.
 

beckiw

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If it's the same provider, performing as the same specialty type, it's an ESTABLISHED PATIENT, regardless of what group they belong to.
The doctor is the what matters, not the group.
 

csperoni

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The original question was that a patient is seeing a physician, but previously saw another physician in a different group, but was the same specialty. Unless the patient had previously seen the current physician, or another physician of the same specialty in the same group, this would be new, not established.
Example: Patient sees Dr. Neuro A. Last year, the patient saw Dr. Neuro B, who is not now, and previously has not been, affiliated with Dr. Neuro A.
This is a new patient to Dr. Neuro A.
 

Pam Brooks

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If they've seen THAT provider in another facility/practice, then it would be established. If they saw a different provider, different practice, but of the same specialty, it's new. Just wanted to clarify, because your question said 'Saw another physician". In that case, it would be a new patient.
 

SharonCollachi

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Agreed. And if you put specific specialties into the question, it becomes more clear. If a patient saw a neurologist at another practice and then came to us and saw our neurologist, are they new or established? Of course they would be new, because that other neurologist and that other practice have nothing to do with you.
 
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