Wiki new vs established.

[Brenda1973]

Documentation guidelines for 99202-99215. Is it correct to say that the only difference in documentation is that new patient requires a physical examination, and a physical exam is no longer required for an established patient. Are there any other documentation differences that I am unaware of? Thank you!

 

[csperoni]

Documentation guidelines for 99202-99215. Is it correct to say that the only difference in documentation is that new patient requires a physical examination, and a physical exam is no longer required for an established patient. Are there any other documentation differences that I am unaware of? Thank you!

What reference are you using that states a new patient requires a physical examination?

 

[xXxPARAGONxXx]

Documentation guidelines for 99202-99215. Is it correct to say that the only difference in documentation is that new patient requires a physical examination, and a physical exam is no longer required for an established patient. Are there any other documentation differences that I am unaware of? Thank you!

That would be incorrect.

For office visits, “new” versus “established” is based on when the patient was last seen and by whom.

AMA CPT 2024 Professional Edition, p. 4,

A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

An established patient is one who has received professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. See Decision Tree for New vs Established Patients.

Neither new nor established patient office visits require a physical examination.

AMA CPT 2024 Professional Edition, p. 7,

History and/or Examination

E/M codes that have levels of services include a medically appropriate history and/or physical examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or caregiver may supply information directly (eg, by electronic health record [EHR] portal or questionnaire) that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in selection of the level of these E/M service codes.