AAPC - Back to school
Results 1 to 3 of 3

Thread: new vs established

  1. #1

    Red face new vs established

    AAPC: Back to School
    True definition of "new patient" ? Example: doc sees pt 1-5-11 at one location, 6 mos later leaves this practice and joins new practice in different state (& now practicing under completely new Tax ID #), sees same patient again after joining this new practice 6/10/11). Would doc bill as a new pt or established pt visit? And why? Thanks!

  2. #2
    Join Date
    Apr 2007
    North Carolina


    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.



    When you change practices

    Consider this scenario: Suppose you leave the practice where you have been working for a number of years to join a new group in a nearby community. Some of your patients transfer their care to the new practice and see you within three years of their last visits. You would report these encounters using an established patient code because, although you are practicing in a new group, you have provided professional services to the patient during the last three years. Note that whether the patient has transferred his or her medical records to your office and how long you may have had those records is irrelevant. The amount of time that’s passed since your last encounter with the patient is the determining factor.


  3. #3

    Thumbs up new vs established

    Thanks Rebecca! Regardless of the documented evidence we supply to the physicians to explain this scenario, it seems it's still unclear and the discussions go on, and on, and on.........intermittently. It's nice to have expert facts and opinions to back up our own. D

Similar Threads

  1. New vs. Established
    By cheri725 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-11-2012, 12:46 PM
  2. New vs. Established
    By thelton in forum E/M
    Replies: 3
    Last Post: 05-26-2012, 07:09 AM
  3. New vs. Established
    By thelton in forum Auditing General Discussion
    Replies: 1
    Last Post: 05-24-2012, 08:10 AM
  4. new vs established
    By bettybutler in forum E/M
    Replies: 1
    Last Post: 04-27-2010, 07:48 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.