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new patient versus established

  1. #1
    Default new patient versus established
    Medical Coding Books
    I know a new patient is anyone not seen in three years time and established is anyone seen within that three year time period, but does that mean also if the patient is in the office having a stress echocardiogram or nuclear stress test makes it an established patient?

    Thank you

  2. Default
    I am not sure I fully understand your question.

    If a patient is being seen for the first time for a stress echocardiogram or nuclear stress test and for whatever reason no E&M is given, the patient is from that point an established patient.

    If your patient is being seen for the first time for a stress echocardiogram or nuclear stress test and an E&M is done, that would be a new patient.

    Is that what you are asking?

    Sorry if I missed the mark.
    Christopher J. Halk, CPC
    Kunsan Air Force Base
    Republic of Korea

  3. Default
    Christopher, so although there was no face to face encounter in your first scenario example-the patient would still be established? If the patient came in and only had a stress test they would be established?

    Amanda, CPC
    Urology coder

  4. #4
    Default
    A patient is not established until they have received a face-to-face professional service with either that provider or a provider of the same specialty in the same group.

    Reading test results is not a face-to-face service therefore if all that was done was the professional interpretation of a test that patient would be new to that provider.


    https://questions.cms.gov/faq.php?id=5005&faqId=1969

    For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.


    Hope that helps,

    Laura, CPC, CPMA, CPC-I, CEMC

  5. Default
    Thank you so much for the clarification Laura.

    Amanda, CPC
    Urology coder

  6. #6
    Smile
    Thank you everyone. So very helpful.

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