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New or Established Patient

  1. #1
    Default New or Established Patient
    Medical Coding Books
    I know folks are tired of hearing about established vs new patients, so I'll make it brief. Dr. "Brown" is in group practice ABC, and has a number of established patients. Dr. Brown leaves ABC group practice and joins DEF group practice (or he flies solo). The patients that follow him from ABC practice to his new paractice are they New or Established?


  2. #2
    Duluth, Minnesota
    they're established - UNLESS they haven't seen Dr. Brown in three years. (regardless of where he's at). Group ABC/DEF or solo ... they're established because they've seen HIM, personally, before. (within 3 years)
    Donna, CPC, CPC-H

  3. #3
    Default Pam
    If this patient that follows Dr. Brown, perhaps to an Associate facility, still established if this patient sees another physician in the facility????

  4. #4
    The patient would be established if s/he has seen Dr. Brown in the new practice prior to seeing the other provider in the new practice. It would be rare if a patient follows a physician and then has the first encounter at this new practice with a different provider, since his/her reason for changing facilities is to stay under the care of the current provider ("Dr. Brown").

  5. #5
    Default New or Established Patient - one more question
    Thanks, I figured that was the answer. One more question though. A baby is born. The pediatrician on call sees the newborn in the hospital. The mom hasn't picked out a pediatrician yet, but she likes the doc that saw her baby in the hospital so she makes the doc the baby's pediatrician. Is this new or established. I know the 3 year rule, but the services rendered by an on-call pediatrician in the hospital are going to be different then a newborn in the office first visit, not to mention the records from the hospital visit are not part of the office record.

  6. #6
    Milwaukee WI
    Default Established baby
    The baby is an established patient once the physician has provided face-to-face services ... even if he had no idea that he would wind up being the child's pediatrician when he saw the newborn at the hospital.

    F Tessa Bartels, CPC, CEMC

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