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New Patient vs Established Patient

  1. Post New Patient vs Established Patient
    Medical Coding Books
    Physician is Family Practice speciality
    Changing from one provider group to another with the same speciality.

    If patient's from old group practice see the same provider at the new group practice should the e/m's be billed as new patient or established patient?

    Patient is new to the group.
    Patient is not new to the provider.

  2. #2
    This is considered an established patient.

    per CPT Page 1, Professional Edition:

    "An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years"

  3. Default
    I agree established patient should be billed.
    Kelly Long CPC, CFE
    Manager Audit and Compliance

  4. Default INITIAL VISIT after consult in Hospital
    If the patient was seen in the hospital and later seen in the physician office for the FIRST TIME.

    Does this get coded as follow up visit or an initial visit?

    Thank you,

    Pawan Arya,

  5. Default
    if by the same physician/specialty-est

  6. #6
    place of service does not matter. That would be an established patient as well

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