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Thread: New vs established in hospital setting

  1. #1

    Default New vs established in hospital setting

    AAPC: Back to School
    I have a question regarding new vs established patient in a hospital setting. We have a physician who covers for our office once a month but is not a provider in our office. If that physician sees a newborn in the hospital for us is that patient a new or established patient when he/she presents to the office?

    Thank you

    Both are the same speciality but not in the same practice or under the same tax id number. So when patient presents to office no one in our office has seen the child nor have we billed any charges.
    Last edited by tuck1999; 06-10-2010 at 03:15 PM.

  2. #2

    Default New vs established in hospital setting

    I think the key factor in new vs estd pt is whether the doctor belongs to the same specialty as the regular provider. If the covering provider belongs to the same specialty then the subsequent visit should be coded as established pt. I hope this helps. thanks

  3. #3
    Join Date
    Apr 2007

    Red face

    I would bill the pt as a new pt because the tax id#'s are not shared. The covering will not be billing an E/M so I would think the fact that the physicians being of the same specailty is not relevant. This is repectfully just my thought....best wishes.

  4. #4


    If you are talking about a patient admitted to the hospital, as it appears you might be, then new/established is not relevant. You would code admit, subsequent, discharge as appropriate.

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