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New or Established

  1. #1
    Default New or Established
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    If a physican saw a patient at practice A then within the year stared working for practice B (B being a whole different business/facility), is that patient new or established? Thank you for any help, I am not sure how to handle this one.

  2. #2
    North Carolina

    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.

  3. #3
    Does it matter whether or not the provider previously practiced under a different specialty, and does this only apply to patients seeing that provider or to patients seeing anyone else in the practice?

    Thank you!
    bev519, CPC, COBGC

  4. #4
    North Carolina
    Quote Originally Posted by bev519 View Post
    Does it matter whether or not the provider previously practiced under a different specialty, and does this only apply to patients seeing that provider or to patients seeing anyone else in the practice?

    Thank you!
    A new patient is one who has not received any professional services, i.e., E/M service or other face-to-face service from the physician or physician group practice (same physician specialty) within the previous 3 years.

    Your physician changed specialties? From what to what? Just curious...

  5. #5
    She is a PA who was in Family Medicine and is now in OBGYN. Some of her patients are following her for their annual exams, but some of them are seeing other physicians in our practice for problems.

    Thank you!
    bev519, CPC, COBGC

  6. #6
    Question What if ...
    another provider in the new practice sees the patient before their regular physician who has transferred to this new group is available to see them?

    Example - Our group just had a doctor from another practice join. Let's call him, Dr. A. He is not available and one of his patients from his previous practice needs to be seen. One of the docs in our group sees the patient. Would they still be considered established? The guidelines do not seem seem specific enough to understand. I know that Dr. A would still bill them as established because he has seen them in the past 3 years, but say, Dr. B or Dr. C see them - they are technically new patients to these docs?

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