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Thread: New patient vs. established patient

  1. #1

    Question New patient vs. established patient

    AAPC: Back to School
    We have a physician that is leaving a group practice to go out on his own. He is purchasing his patient medical charts from the group. He will be billing under a new tax id number once out on his own. Since he is purchasing his patients' charts, when he sees the patients under his new tax id number, will they be considered new patient visits the first time he sees them, or established visits? Also, can he reference back to previous HPI and PFSH to say that he has reviewed them for changes or no change?

  2. #2
    Join Date
    Apr 2007
    Albany, NY

    Default Established patients

    A PFSH and ROS can be credited from prior documentation assuming the documentation indicates what PFSH/ROS was reviewed and for audit's sake, where they reside (location and date of the originals). "No change from ROS in office note dated 12/1/2009", for example.

    As for the change in TIN, the patient's would still be established by CPT rules. The patient has to have not been seen by YOU or a member of your group practice of the same specialty in 3 years. It doesn't matter where.

    Here's an article that illustrates this point from the perspective of an MD joining a different group practice (not exactly the same, but enough the same to support my position):

    When you change practices

    Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that’s passed since your last encounter with the patient is the determining factor.


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