Wiki New vs Established Patient Clarification

[AthensCoder]

Hello Fellow Coders,

I have a new provider to our group who saw a patient that he previously saw 2 1/2 years ago at his old practice, which has a different tax-id. The patient has Medicare and received a denial that only one evaluation and management code at this service level is covered during the course of care . Per Medicare guidelines the definition of a new patient is "an individual who did not receive any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the previous three years? Since we are under a different tax-id and are not affiliated with his previous group would the patient qualify as a new patient or am I interpreting this all wrong?

 

[Cynthia Hughes]

The patient is established to your physician regardless of the group practice under which his/her services were billed. Do not apply the "same group practice" to your physician. However, because the patient is established to your physician, the patient is also established to another physician of the same specialty and same group practice.