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Thread: New VS Established

  1. #1

    Default New VS Established

    AAPC: Back to School

    We are a multi spec. ortho group with 2 hand surgeons credentialed for their sub-specialty hand, all billing under the same tax ID # Can our hand doc. charge a new pt visit if the pt was refered by our knee doc. all in the same group same tax ID#?

    Thank you for any help.

  2. #2
    Join Date
    Apr 2007
    New Windsor, NY


    New Patient.

    I believe the "Decision Tree for New vs. Established Patients" listed in the 2010 CPT is no longer present in the 2011 CPT, but the guideline still stands. Different specialty means new patient.

    Last edited by QodingQueen; 03-09-2015 at 10:02 AM. Reason: privacy reasons

  3. #3


    Cheryl I looked everywere in the CPT 2011 book. I knew I had seen it somewere never thought to look in 2010.

    Thank you

  4. #4
    Join Date
    Apr 2007
    New Windsor, NY


    You can find more information about the deletion of the "Decision Tree" in the CPT 2011 in April 2011 Coding Edge "Make the Most of CPT at Your Fingertips" at the bottom of page 24. See quote below.

    Best of luck to you.

    "Decision Tree Takes a Vacation, but Still Applies
    The New vs. Established Patient Decision Tree, which previously
    was included in the Evaluation and Management
    (E/M) Services Guidelines section, does not appear in the
    CPT® 2011 Professional Edition. Peter A. Hollmann, MD,
    vice chair of the AMA CPT® Editorial Panel, announced
    on Nov. 10, 2010 at the CPT® and RBRVS 2011 Annual
    Symposium in Chicago that the omission of the New vs.
    Established Patient Decision Tree from CPT® 2011 does
    not represent a change in policy regarding how to determine
    whether a patient is new or established. The definition
    of “new” and “established” patients in the Evaluation
    and Management (E/M) Services Guidelines remains unchanged
    from 2010. Hollmann predicts the New vs. Established
    Patient Decision Tree will reappear in the 2012
    edition of CPT®."
    Last edited by QodingQueen; 03-09-2015 at 10:03 AM. Reason: privacy reasons

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