The key to detemining this is that the doctor has to have a face-to-face visit with the patient. If the physician or another physician of the same specialty in the group has not seen the patient face-to-face in a three year period, then that patient is considered a new patient. If there is no face-to-face contact, then the first time the doctor sees the patient it is a new patient visit.
For example, at our Urgent Care we administer flu shots, PPD's and drug screening. The patient has never been seen by the doctor, but he still issues an order for the nurse to perform these services. If the patient returns at a later date for an illness and the doctor now treats the patient - he will bill a new patient visit for this encounter as this is the first time he is seeing the patient face-to-face.
I hope this helps.
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