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Thread: Established Patient?

  1. #1

    Default Established Patient?

    AAPC: Back to School
    A patient had an episode of hospital admission & discharge recently. Patient is now seen in the office by the same provider or another provider from the same group. Is the office visit considered a new patient or established patient?

    Simple questions often throw us out of gear!

    Any inputs will be greatly appreciated.


  2. #2
    Join Date
    Apr 2007
    Bangor, Maine


    I, personally, would say "established" but only because the wording in the CPT book states:

    "...a patient who has received any professional services by that physician in the last 3 years."

    So I would say that a hospital admit would count as a professional service.
    On another note, if you look at the decision tree on page 5 of the 2010 CPT book, it also may depend on whether the patient is being seen for the same specialty or subspecialty, but I am assuming, for this case, that the patient is probably following up after the initial hospital visit, but that is only an assumtion.

    Anyone else??

  3. #3


    We have to bill the current encounter as established patient service.
    Jagadish, CCS-P, CPC

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