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Wiki new vs established patient

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bluemoon1

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A patient is seen by his doctor within the 3 year period. Can a practice determine that if a patient is not seen for over a year but
less that 3 years that he be coded as a new patient? Thanks much
 
No, the 3-year definition for a new patient is stated in CPT. An individual practice cannot change CPT definitions. To bill a patient as new if they were seen by the provider within the last 3 years would be a misrepresentation. There would also be no benefit to doing this because almost all payer claims systems will catch this error and deny the claims.
 
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