Results 1 to 2 of 2

New vs est pt /3 year rule-NOT MEDICARE

  1. Default New vs est pt /3 year rule-NOT MEDICARE
    Medical Coding Books
    We have a question regarding the new patient vs. established/three year rule for Non-Medicare Patients. It is the same question below that we found on the NGS Medicare website from a teleconference, they had in 2010 and posted it on 3/3/2010 and they gave their reply below.

    However, does this apply to non-medicare patients

    New vs. Established/Three Year Rule

    We have new physicians joining our practice from other practices. For example, we have a new orthopedist. He saw a particular patient in his previous practice under a different tax ID, within the three year limit. When he sees the patient for the first time within our practice, can we bill it as a new patient?

    Medicare's Answer: The new patient rule is based on the physician who renders the service. If this physician has seen the patient within the past three years, even in a different practice, this does not represent a new patient visit.

    Remember I would like to know if this is only a Medicare Rule?

    Thank you Toni P

  2. #2
    Evansville Indiana
    Default New vs. established
    This is a CPT guideline, so it should be followed by all payers. You can find the guideline in the CPT book just before the E&M codes under E&M Services Guidelines, then under New and Established Patient. They also provide a decision tree for new vs established.
    So to answer your question this would be an established patient whether they are Medicare or not.

Similar Threads

  1. New Patient-3 Year Rule
    By casey3266 in forum E/M
    Replies: 2
    Last Post: 05-12-2015, 10:33 AM
  2. 3 year rule on established pt's ?
    By in forum E/M
    Replies: 2
    Last Post: 04-16-2015, 01:34 PM
  3. 2/3 Rule using MDM for Est Pt
    By madsmacpc in forum E/M
    Replies: 1
    Last Post: 06-02-2014, 12:27 PM
  4. New Patient vs Established 3 year rule?
    By tholaday in forum Family Practice
    Replies: 1
    Last Post: 06-14-2012, 04:35 AM
  5. 3 year rule
    By krssy70 in forum E/M
    Replies: 1
    Last Post: 07-26-2011, 01:40 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?


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.