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Thread: 3 year rule when billing e&m visits

  1. #1

    Default 3 year rule when billing e&m visits

    AAPC: Back to School
    Having a discussion in the office concering the guidelines for the billing of the 3 year rule for the E&M coding. I have a doctor who was in a practice last October and left to join a new practice. We are having his patients from the old practice follwo him th the new group practice he has joined. I believe the way the E&M guidelines read is that my doctor should be able to charge his old patients who come to see him from the old practice to the new practice a "New Patient Visit".

    Any imput would be greatly appreicated

    Thank you,

  2. #2
    Join Date
    Apr 2007
    Coastal Coders

    Default From AAFP Web site

    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


    I understand your point. I am just reading out of the AMA 2011 CPT and it states" A new patient is one who has not recieved any professional services from the physician or another physician of the same specialty who belongs to the SAME GROUP PRACTICE, within the past three years." That was what I was stated my opinion on.
    Your thought

  4. #4
    Join Date
    Apr 2007
    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. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.


    Page 51

    If the provider has seen this patient within the last 3 years, it's established; regardless if it's a new practice.

  5. #5
    Join Date
    Apr 2007
    Cherry Hill, NJ


    You can bill a visit as new and will get paid because of the different tax id number, but in an audit by the carrier they will request a refund. Sorry.

  6. #6
    Join Date
    Apr 2007
    Phoenix, AZ


    I agree with the above. The patients are established with the doctor and should be billed as such.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

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