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new vs. established???

  1. Default new vs. established???
    Medical Coding Books

    I began working in a OB/GYN office at the beginning of the year after coding outpatient surgery for 4 years. My question involves new vs established E&M encounters:

    Let's say one of our doctors does a C-section on a patient while they are on call (a patient who has never been to our office before), and the doctor also discharges this patient from the hospital. Then the patient comes to our office for their 6 week postpartum exam. Is this patient considered a new patient since they are new to our office, or established since they already had a hospital encounter with the doctor??

    please help!


  2. #2
    Default Established
    CPT defines an established patients as having received face-to-face services rendered by a physician and reported by a specific CPT code.

    You can find the complete definitions on the first page of the E/M service guidelines in the CPT book.

    Laura, CPC

  3. Default
    Hi Laura,

    I did read that section prior to posting my question....I should have mentioned that I would take that to mean if the doctor is seeing these patients in the hospital and then they have an appt with us, they are established. Would you agree?

  4. #4
    Greeley, Colorado
    Regardless of where the physician first saw the patient, once a service is rendered the patient would be considered established for the office visit. Keep in mind that you should be coding 59515 for the C/S and postpartum care, so there would not be an E/M reported for the postpartum visit.
    Lisa Bledsoe, CPC, CPMA

  5. Default
    Thank You!

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