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New -vs- established

  1. #1
    Default New -vs- established
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    Ok me and my associate are of different opinions....someone please advise.
    Our doc was on call and did an emergency surgery brought in through the er.
    This was not one of our patients. She came into our office at a later date (after global time) for an office visit. Is she a new patients because she's never been in our office?
    or is she an established patient since we have billed services for her under our tax id?


  2. #2
    Evansville Indiana
    Default New vs established
    Since your physician performed a face-to-face service with this patient within the last three years, the patient would be established.


  3. Default
    The patient is established.

  4. Default A little confused now...
    Ok... Here is my situation. I have a Dr. who works in the practice 3 days a week and in the ER one 24 hour shift. We have had patients come in who have never been to our practice before but did see him in the ER. And you are saying that they are established patients. My question is, how do we know this as coders? Is the Dr. supposed to dictate this? Or is it new because we have not established them in our practice? I understand both points above, but now I am unsure!

  5. #5
    Milwaukee WI
    Default Established
    If the patient has seen the physician (or any other physician in the same practice, same specialty) within the last 3 years for ANY face-to-face encounter, the patient is ESTABLISHED.

    There's no wiggle room in that definition. Doesn't matter if the doctor saw the patient in another clinic, in the ER, in a nursing home, or at home.

    Curious - who billed for his services when he performed the emergency surgery?

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Exclamation
    What about when the new practice has no access to a shared record? To elaborate:
    When a physician leaves a practice entirely, and cannot take any of the record with her how can it be established if the she and the physicians at her new practice have no access to the patient history, etc?

    When a patient is seen in the ER by a physician, or rounding in a hospital or nursing home, etc... that physician has immediate access without a signed release. He can just pick up the phone and ask and he will have the history that was obtained from the previous visit. You cannot do that with a separate practice/office.

    Does any of this make sense?

    Thank you

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