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New office visit after in patient consult?

  1. Default New office visit after in patient consult?
    Medical Coding Books
    Patient seen by oncologist as a consult on an in-patient basis. When patient is discharged from the hospital and has a follow-up visit with the oncologist a week later is the patient considered a new patient or established?

  2. #2
    Hartford, CT
    Pt is an establlished patient if they have received ANY professional services from the physician within the past three years, there is no allowance for different place of service. So if the pt was seen in the hospital then comes to the office that pt is considered established.

  3. #3
    Can anyone tell me where I can find an actual guideline to support this answer? We are working on Audits and this question keeps coming up.

    Patty Kellogg, CPC

  4. #4
    North Carolina
    Other than you CPT book, refer to CMS's definition.

    A. Definition of New Patient for Selection of E/M Visit Code

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., E/M service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous 3 years. For example, if a professional component of a previous procedure is billed in a 3 year time period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit. An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

    Rebecca CPC, CPMA, CEMC

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