Wiki New vs Established criteria following Emergency department visit

[anandh]

Dear All,


I would appreciate your guidance on the criteria used to determine whether a visit should be considered new or established.
For example, a patient was seen 10 days ago in the Emergency Department by a gynecologist. The patient is now seen again by a gynecologist after 10 days. In this scenario, should the visit be classified as a new or established patient visit?
Kindly advise.


Best regards,
Anandh

 

[jkyles]

Hi there, there's a decision tree in the E/M guidelines of your CPT manual. This AAPC article is also helpful https://www.aapc.com/blog/41276-new...faix2U4cAtDkoDGQEVak1FxdIpaUN65hoCuOIQAvD_BwE

 

[csperoni]

If both physicians are the same specialty/subspecialty and part of the same group practice, this is established. The location of the prior service is irrelevant.

https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

New and Established Patients
Solely for the purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by physicians and other qualified health care professionals who may report evaluation and management services. A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other 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 or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. See Decision Tree for New vs Established Patients.