Depends on the intent.
If there is just a transfer of care (which is indicated by the word refer) it would be a new patient(if they have not seen another spine surgeon in that group within 3 yrs), because they are different specialties. If they had seen one of the spine surgeons in that time frame it would be established.
If it is a request for opinion then you would have a consult if the 4 R's are met.
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