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Thread: New patient?

  1. #1

    Question New patient?

    AAPC: Back to School
    One of the physicians in our practice recently left the practice. Patients that previously saw this physician are now treating with one of the other physicians in our practice. These patients are essentially new to the physician now treating them, but can we bill it that way? We bill under a group tax ID & NPI, so I'm pretty sure Medicare would not allow a new patient code. Any thoughts or insight? Thanks!

  2. #2
    Join Date
    Apr 2007
    Greater Pittsburgh


    no, established patient, unless it's been over 3 years since the patient was seen by your group.
    Last edited by jdemar; 07-12-2010 at 05:39 AM.
    jdemar, CPC, CMA

  3. #3
    Join Date
    Apr 2007
    North Carolina


    I agree

  4. #4


    The patient should be coded as a NEW patient. The November 2009 issue of The Coding Edge has a whole article about this type of situation. AAPC states that the patient is considered new whether following AMA or CMS guidance.

  5. #5
    Join Date
    Apr 2007
    North Carolina


    I disagree. The medical records are still available for the remainding providers review.

    CMS=Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years.

  6. #6


    I disagree as well, but evidently the option is there if a provider wants to bill for a new patient. It was news to me reading the article in Coding Edge and I listed the example they used below. However, they also go on to state that just because it's okay to bill as a new patient not all carriers will pay. I personally wouldn't bill for a new patient unless the provider requested it because I think I would spend more time trying to get it paid than it's worth, but like I said at least the option is there for those that want to try it. Also, it had been a while since I read the article and I was mistaken when I said this was also true under CMS guidance. CMS does not agree and requires the patient to be billed as an established patient.

    "For instance, Dr. Jones joins a group practice and sees Mr.
    Smith for the first time. Mr. Smith has received a professional
    service from another physician in the group practice
    within the past 36 months, but Dr. Jones is seeing Mr. Smith
    for the first time in the group practice and has not billed a
    professional service for Mr. Smith under any tax ID within the
    previous 36 months. In such a case, CPT® Assistant guidelines
    would allow Dr. Jones to bill Mr. Smith as a new patient."
    Last edited by cjohnson02; 07-09-2010 at 02:02 PM.

  7. #7


    Then I say the article is 100% INCORRECT. You CANNOT code this as a new patient.

  8. #8
    Join Date
    Apr 2007
    WHills, CA

    Default Established

    The authority here is who are the ones who develop and publish the CPT and who are in collaboration with that authority. I never go by what an article says regardless of where it came from. I research the founding authority and back it up with ther published regulations and what is final rule. Here it is AMA, American Medical Association. In the CPT, it has clearly stated the rule to follow for this situation.

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