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New vs. Established

  1. #1
    Default New vs. Established
    Medical Coding Books
    I have a doc who is part of our group of orthos, he also is part of another group not affiliated with us and under a different tax id #.

    so if his pt. see him at that office under that tax id and then comes to our office to see him under our tax id - is the pt. new (different tax id) or is the pt. established as they have been treated by him before??

    I beleive the pt. would be establised as they have been treated by him before, but the different tax id's are confusing me.

    please help!
    thank you!

  2. Default
    The establishment of care is based upon face to face evaluation with the physician. If the patient has seen the physician within the last 3 years, regardless of where the patient saw the physician, they are still considered an established patient.
    We have a physician that was practicing in Texas, but has since moved to New Mexico. A few of his patients travel to NM for medical treatment. Because they were evaluated by the physician within the last 3 years, we could not charge a new patient visit, as they had established care when he was practicing in Texas.

  3. #3
    Minneapolis MN
    You are correct, the second visit would be established even if seen in another Tax ID. Tthe first line of criteria is provider even if using different Tax IDs. We follow this same strategy when a provider starts new at our healthcare organization and brings his/her patients with them - we would use established patient visits.

  4. #4
    thank you that is what i thought!

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