new vs. established

cingram

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ok here is the question. the doctor does a consult in the hospital, then xxxx weeks later that patients comes into the office, is that office visit considered a new patient or established patient? If possible can you provide documentation so i can present this to the doctor?
 
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Hi, Cingram. I am only a new CPC-A, so take this for what it's worth. In looking in the CPT on page 17
upper right paragraph, it looks like this is an established.
 

rthames052006

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ok here is the question. the doctor does a consult in the hospital, then xxxx weeks later that patients comes into the office, is that office visit considered a new patient or established patient? If possible can you provide documentation so i can present this to the doctor?
The rule is:

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

An established patient is one who has received professional services fromtehphysician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

As the other poster mentioned. This information can be found in your CPT book at the begininning of the E/M Section.

So I pose a question to you. Is this patient now coming to the office to see the same provider he/she saw in the hospital? If so then this is an established patient.

If this patient is seeing a differant provider in the same group with a different subspecialty this could be a new patient visit.

Is this patient being seen as a f/u to the hospital visit?
 
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cingram

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This is what I thought but I was told that because the doctor is doing a consult he is not assuming care of the patient that is the job of the admitting physician. but I was just brought up with this senerio I do all the anesthesia coding in the office and this is not one of my clients but the question came up. From my understanding he saw the patient in the hospital and did a consult then the patient did a f/u with him in the office.
 

mhstrauss

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This is what I thought but I was told that because the doctor is doing a consult he is not assuming care of the patient that is the job of the admitting physician. but I was just brought up with this senerio I do all the anesthesia coding in the office and this is not one of my clients but the question came up. From my understanding he saw the patient in the hospital and did a consult then the patient did a f/u with him in the office.
Based on the add't info you provided here, this f/u visit should be an established patient visit.
 
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