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Thread: Established vs New PT Conflicting Info

  1. #1

    Default Established vs New PT Conflicting Info

    AAPC: Back to School
    Receiving conflicting info for the following, can anyone help?

    Anesthesiologist administered anesthesia to a surgical patient several years ago under a different practice. Recently, the anesthesiologist began treating the same patient for pain under a different practice. How would the E/M be billed?

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    1. If the bill for the previous procedure went out with a different tax ID than he/she has now, then the patient is new.

    2. If the previous encounter was 3 years ago or longer then it is a new patient regardless of the tax ID.

    See the New Vs. Established patient flow chart in the CPT book for more info.
    Walker Bachman, CPC, CPPM

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Established patient if within 3 years

    Regardless of whether the anesthesiologist was with a different practice, if face-to-face service was provided within the last 3 years by the same physician or by the same practice the patient is considered established.

    So if the anesthesiologist provided service to the patient within the last 3 years, the patient is established.

    If the patient was seen by another physician in this practice of the same specialty within the last 3 years, the patient is established.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    Athens, Ga.


    Tessa is correct.. my advice was a littte off-base.....sorry!
    Walker Bachman, CPC, CPPM

  5. #5



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