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Wiki New vs Established

cdrcpc1

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I?m hoping to get some clarification in regards to a New vs Established patient visit. I work for an Occupational Health and Immediate Care Clinic.
We do physical exams for companies with new hires and bill the company directly for the physical exams. If a patient that was seen for a physical returns within three years for treatment of an injury or for an illness would the patient be considered a New or Established patient? My understanding is that if patient is seen by a provider within our organization for a physical exam then returns within three years it would be an established visit. One of my co-workers seems to think patient should be considered a New visit because we did not bill an insurance company for the physical exam. Am I right or wrong? Any input is much appreciated.


:confused:
 
Was it same specialty and subspecialty as the person they saw in the last 3 years? If it was then no you cannot bill a new patient. Just like you cant bill a new patient just because they switch insurance.

The E&M guidelines in the CPT book should be followed to determine if its a new patient. There is a nice flowchart in there.
 
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