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Thread: New Patient Definition applies to any POS?

  1. #1
    Join Date
    Apr 2007
    San Juan

    Default New Patient Definition applies to any POS?

    AAPC: Back to School
    Six months ago I red that CMS has clarified the “New Patient Definition”. This new definition states that it does not matter of the POS patient would be considered “established” if he/she was seen in the past three years.

    Can some one please tell me which CMS document states this? I already checked the Medicare Claims Processing Manual.

    Gabriel Rafael Aponte, MBA, RN, CPC, COC, CIC, CRC, CPMA, CCC, CHONC, CCS, CCS-P, CDIP

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Requires face to face.........

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. 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.



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