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New Patient or Established w/in same group

  1. Unhappy New Patient or Established w/in same group
    Medical Coding Books
    Does anyone know where I can find information to share with my doctors regarding billing for a new patient vs an established patient within the same group? EX: An Endocrinologist referred a patient to see an Internal Medicine physician within the same group with the same tax id. According to what I read in the guidelines in the CPT book we can bill as a new patient. But I need further documentation to support this to show a physician that is telling me I am incorrect. Any help would be appreciated. Thank you.

  2. #2
    North Carolina
    A Definition of New Patient for Selection of E/M Visit Code

    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. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit

    Page 47-48

  3. Default
    Thank you Rebecca for your assistance.

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