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New/Established Patients

  1. #1
    Billings, MT
    Default New/Established Patients
    Medical Coding Books
    We are having a difference of opinion at my hospital that I need help on. We have a physician that is an internal medicine doctor with a sub specialty of Nephrology. But she only uses one tax ID number. She saw a patient in the out patient internal medicine clinic and is now seeing the patient at the same clinic but for a kidney problem. She wants to charge the patient as a new patient. Is that correct because I would say that if she has seen the patient in the last three years then the patient would be considered an established patient regardless of the specialty.
    Jennifer Pfister, CPC

  2. Cool
    patient would be "established"

    Reference: CPT E/M Guidelines; Definitions of Commonly Used Terms; New and Established Patient
    "A new patient is one who has NOT received ANY "professional services" (face to face) from the physician or another physician of the same specialty who belongs to the same group practice within the past three years."

    Hope this helps. (The physicians always want to "see it in writing".

  3. Default
    Absoutely it is an established patient

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