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New or Established?

  1. Default New or Established?
    Medical Coding Books
    I have seen the questions related to this topic but only for office place of service. But I have a little different scenario.

    This is a very large debate with my physicians and I would like clarification. If anyone can point me to a policy, regulation or rule that I can show my physicians that would be a definate plus. I believe it doesn't matter what location they saw the patient, face-to-face has no boundaries.

    Scenario#1
    Patient was seen in the hospital as inpatient by one of our physicians and then the patient came to back to our group practice 1 year later in the office. Is this patient new or established?

    Thank You,
    Jodi

  2. #2
    Default
    If they are the same specialty then the patient is established.

    You are correct, it doesn't matter if you go from inpatient to outpatient to office, face to face is face to face.

    Check out the definition of New and Established Patients in the E/M section of CPT. I think it is pretty clear.

    Good luck,

    Laura, CPC, CPMA, CEMC

  3. Default
    Quote Originally Posted by jmazzone View Post
    I have seen the questions related to this topic but only for office place of service. But I have a little different scenario.

    This is a very large debate with my physicians and I would like clarification. If anyone can point me to a policy, regulation or rule that I can show my physicians that would be a definate plus. I believe it doesn't matter what location they saw the patient, face-to-face has no boundaries.

    Scenario#1
    Patient was seen in the hospital as inpatient by one of our physicians and then the patient came to back to our group practice 1 year later in the office. Is this patient new or established?

    Thank You,
    Jodi
    They are established. They already had a face-to-face... doesn't matter where. Look in the guidelines. It should be there.

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