There is a difference between a new patient and a new problem. An established patient can have a new problem. So don't get confused with the CPT guidelines on what constitutes a new or established patient.
Because ER doctors do not generally provide any continuum of care to patients, it is usually presumed that every problem (not every PATIENT) that comes to the ER is a new problem.
However, if the ER documentation clearly refers to a patient having been at this ER "yesterday," or "last week" or "3 times this year" for this same complaint, then I'd consider it an existing problem.
So when I showed up at the ER with a severe nosebleed on Tuesday, and then had to go to the ER again on Sunday with the same problem ... it was an existing problem on Sunday.
On the other hand ... if I went to my PCP on Tuesday with my nosebleed, but had to go to the ER on Sunday with a nosebleed ... it's a NEW problem to the ER staff because they haven't worked me up or treated me for it recently.
Injuries, however, are ALWAYS new problems. So if I came in with a bloody nose as a result of an ACCIDENT on Tuesday and came in with another bloody nose as a result of another accident on Sunday, it's a new problem on Sunday.
(Boy, I sure am having a lot of bloody noses! ... lol)
Hope that helps.
F Tessa Bartels, CPC, CEMC
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