This is our state's definition...
A new patient is one who is new to the physician or an established patient with a new industrial injury or condition. Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.
An established patient is a patient who has been seen previously for the same industrial injury or illness by the physician.
In the instance where a physician is on call for or covering for another physician, the patientâ€™s encounter will be classified as it would have been by the physician who is not available.
No distinction is made between new and established patients in the emergency department. E/M services in the emergency department category may be reported for any new or established patient who presents for treatment in the emergency department.
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