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Established Patient?

  1. #1
    Default Established Patient?
    Medical Coding Books
    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
    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. Default
    We have to bill the current encounter as established patient service.
    Jagadish, CCS-P, CPC

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