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New vs Established patient

  1. Default New vs Established patient
    Medical Coding Books
    I have a question regarding new vs established patients. I work for a hospital that employees 10 physicians. My question is... when a patient's primary physician refers the patient to a specialized doc employeed by the same facility would you charge a new patient E/M for the specialized doctor or an established patient E/M?

  2. #2
    Evansville Indiana
    Default New vs established
    If the physician is credentialed in a recognized specialty, then if they or no one else in the practice with the same specialty has seen the patient in the last three years it would be a new patient.

    CPT guidelines
    "A new patient 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."

  3. Default New vs Established patient
    If the providers belong to the same specialty, the pt would be considered established. If the providers belong to different specialties, the pt would be considered new. However, if the provider asks for opinion and advise even from another provider in the same practice, it would be considered a consult.

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