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Thread: New and Established just won't go away

  1. #1

    Default New and Established just won't go away

    AAPC: Back to School
    I have been dealing with questions for docs about new and established patient for years. Here is the newest scenario.
    A neuro group, subspecialty movement disorders, adds a physician who is bringing his patients with him. Would those patient's, the one's who haven't been seen by the group or any member of the group in the same subspecialties, be new? I explained that they would probably be established and they would all require extra time so there are a few ways we could use modifiers and prolonged visit codes in certain circumstances. I alos told him that I would try to locate a specific rule or exception with regard to this situation.
    If anyone knows of an exception could you please let me know or if I am wrong I would really like that.

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Established

    They are established if they have been seen by the same physician OR another physician of the same specialty and same practice. Since they were HIS patients before he came to your practice, they are established patients if he's seen them within the last 3 years.

    NOTE - even if patient Jones, who has seen Dr New previously shows up when Dr New is out of the office and is then seen by one of the other physicians in the same specialty at this practice, that patient will be ESTABLISHED.

    Hope that helps.

  3. #3
    Join Date
    Apr 2007

    Default New Practice Patients

    Take a look at this article. I hope it helps.


    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.
    Heather Winters, CPC, CFPC

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