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New vs Esta Pt

  1. #1
    Default New vs Esta Pt
    Medical Coding Books
    i know all about the 3 year rule and about the speciality rule, but when it says " a patient is considered established if they have seen a physician in that same specialty within 3 years" does it mean ONLY that specialty ?? i work in a hospital. So if a patient is seen in OB/GYN then in Opthalmology would they be new patient of established because they were seen by another specialist in that group ? i was told since we are a group then all specialties are treated the same, you are only new patient if you haven't seen any type of specialist in our group, regardless of what type of specialty.. im starting to get confused !!

  2. #2
    I work for a multi-specialty clinic (4 specialties) so it is not on the same scale as you but we bill a patient as a new patient if the patient has not seen one specialty in the past 3 years but has seen another. For example: A patient is a regular patient for our cardiologist but starts having GI symptoms and is referred to one of our GI docs. The patient has never seen one of our GI docs so we bill that patient as a new patient. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    Greeley, Colorado
    I work for a large multi-specialty group practice. Same as Susie said - if the patient is established in one specialty, but needs to be seen in another specialty, they are considered NEW to that specialty and therefore coded as a new patient. "New" is based on specialty, not on group. Hope that helps.

  4. #4
    yes i agree with both of yall, i just wanted to make sure that was the rule everyone follows,, thanks

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