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New patient vs Est patient

  1. #1
    Central Mississippi
    Default New patient vs Est patient
    Medical Coding Books
    Recently a FNP joined the Pediatric group that I manage. Some of the patients that she saw at her other practice have followed her over here. I say that these patients are established, as she has seen them within the last three years. Her and the physicians are saying the patients are new, because she is with a new group and new specialty. My thought process is "her specialty has not changed, she is still a FNP".
    Please let me hear your opinions. New or established???

  2. #2
    You are right. Since she has seen the patient before, they would be established. There is a good article on the AAFP website that explains it for them (though CMS has the info out there too):
    It is from 2003, so be sure to make sure most still applies but it still seems to be current.
    From that article:

    When you change practices
    Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that's passed since your last encounter with the patient is the determining factor.

    There is also the decision tree in the E/M section of the CPT book.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

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