Question New vs Established

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Here's the scenario: Physician Assistant Jones worked for Medical Group ABC in 2020, during this time the internal medicine physician who over sees PA Jones, Dr. Smith, saw patient Y. M. In 2021, PA Jones leaves Medical Group ABC and joins Medical Group XYZ, at which time patient Y.M. comes to PA Jones for follow up/establish care with this new Medical Group as Dr. Smith retired. Please note PA Jones never saw this patient while employed at Medical Group ABC. Is patient Y.M. considered a new or established patient at Medical Group XYZ? My supervisor states the patient is established since PA Jones worked under Dr. Smith and it does not matter that the patient was not seen by him. I disagree as PA Jones has a separate NPI than Dr. Smith, therefore the patient is new.

Thanks for any help you can give me.
 

SharonCollachi

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New Patient​


Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.

For example, if a professional component of a previous procedure is billed in a 3-year time period, (e.g., lab interpretation) and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or electrocardiogram (EKG) etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

If a patient was seen by a physician in a clinic and sometime during the 3-year period was seen again by that same physician at the same clinic, at another clinic, or in this physician's private practice, this is still an established patient situation. If this patient sees another physician of the same specialty and subspecialty at a location where the first physician also practices, this is also an established patient situation.

***********************************************

The patient has not seen the practitioner before, and has not seen anyone at the practice before. The patient is new.
 
Messages
4
Location
Powell, WY
Best answers
0

New Patient​


Individual who has not received any professional services, Evaluation and Management (E/M) service or other face-to-face service (e.g., surgical procedure) from the same physician or physician group practice (same physician specialty and subspecialty) within the previous 3 years.

For example, if a professional component of a previous procedure is billed in a 3-year time period, (e.g., lab interpretation) and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or electrocardiogram (EKG) etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

If a patient was seen by a physician in a clinic and sometime during the 3-year period was seen again by that same physician at the same clinic, at another clinic, or in this physician's private practice, this is still an established patient situation. If this patient sees another physician of the same specialty and subspecialty at a location where the first physician also practices, this is also an established patient situation.

***********************************************

The patient has not seen the practitioner before, and has not seen anyone at the practice before. The patient is new.
I totally agree with you that the patient is new, however my supervisor is saying the patient is established, so now I have to try to convince her. Thank you for responding.
 
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