Wiki New vs. Established Patient

[nturner1]

Question: Should a patient who was seen by anesthesiologist in the clinic be considered new or established if he or she had anesthesia services in the OR (within 3 years)?

 

[jkyles]

The patient received a professional service from the anesthesiologist, therefore they are established.

 

[nturner1]

The patient received a professional service from the anesthesiologist, therefore they are established.

Thank you, just to be sure. Are you saying that the service provided in the OR by the anesthesiologist is considered a professional service?

 

[naomi.weierich]

Thank you, just to be sure. Are you saying that the service provided in the OR by the anesthesiologist is considered a professional service?

a professional service is defined as a service within one’s profession. This would not be limited to anesthesia services beginning in 00, but also evaluation and management services, for example. It is also is not limited to a particular place of service. This 3 year rule applies to providers of the same primary and secondary specialty (per credentialing, which is why it is essential to know how your providers are credentialed) in the same practice.

 

[jkyles]

Thank you, just to be sure. Are you saying that the service provided in the OR by the anesthesiologist is considered a professional service?

Yes. If a provider sees the patient and performs a medical service, the patient becomes established for that provider and any providers of the same specialty and group for 3 years no matter where the later visit(s) take place, or if the provider billed an insurer for the initial service. An example with an anesthesiologist might be: Anesthesia care for a surgery in hospital in 2022. Patient also has back pain and goes to the anesthesiologist's practice for pain management in 2023. That patient is established.

 

[nturner1]

Thank you!