Results 1 to 3 of 3

New patient vs Established patient

  1. Default New patient vs Established patient
    Exam Training Packages
    I code the physican services for our 2 clinics and our hospital. The hospital owns us and we are all under the same tax id number. I have a couple questions the first is. If I have a patient that is seen in the ED by the PAC for ie abdominal pain and is told to follow up in the clinic if the pain continues. Would that patient be new or established when they come in to our clinic and are seen by my MD or a different PAC? Second question my physician delivers baby in the hosp and than the baby comes in for a WCC. Is the baby new or established? My thought is they would be establised due to the face to face care. Is the correct. Last question we have a surgeon under the same tax id number. He hold clinic on Monday and Wednesdays. Surgerys Tuesday and Thursdays. If I have an established patient to our group self refer themselves for his opinion for an EGD... would he/she beconsider new or established. Would his specialty change the rules?
    Thanks
    Nichole

  2. Default
    If I have a patient that is seen in the ED by the PAC for ie abdominal pain and is told to follow up in the clinic if the pain continues. Would that patient be new or established when they come in to our clinic and are seen by my MD or a different PAC?

    If the patient sees a provider of the same specialty, then patient is EST

    Second question my physician delivers baby in the hosp and than the baby comes in for a WCC. Is the baby new or established? My thought is they would be establised due to the face to face care. Is the correct.

    Baby is EST

    Last question we have a surgeon under the same tax id number. He hold clinic on Monday and Wednesdays. Surgerys Tuesday and Thursdays. If I have an established patient to our group self refer themselves for his opinion for an EGD... would he/she beconsider new or established. Would his specialty change the rules?

    If the patient has not been seen in 3 years by the surgeon's specialty, then patient is NEW to that specialty

    New patient rule is: “A new patient (99201-99205) is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”

  3. Default
    Thank you!!

Similar Threads

  1. Replies: 10
    Last Post: 04-27-2017, 08:14 AM
  2. New Patient vs Established Patient Code
    By pvacanti in forum Billing/Reimbursement
    Replies: 4
    Last Post: 05-14-2014, 09:00 AM
  3. new patient vs established patient guidelines in a SNF-please help
    By CTRAVIS in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-27-2014, 09:46 AM
  4. Urgent care new patient vs established patient
    By ewheeler in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-12-2012, 12:53 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.