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Thread: New Pt vs Established Pt

  1. #1

    Default New Pt vs Established Pt

    AAPC: Back to School
    If our surgeon sees a patient in the hospatal and then the patient comes to office for a follow up visit is the pt considered a new or established pt? Thank you for your help!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Established

    For the thousandth time .... Established

    If the patient has received ANY face-to-face service from the physician (or another physician of the same specialty and same practice) in the last three years, the patient is ESTABLISHED.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

    P.S. Sorry to sound cranky but this question has been asked and answered a bijillion times.

  3. #3


    I knew the answer was established but I had to get something in writing to show the rest of the office so they would believe me.

  4. #4


    Another suggestion: perform a search on these forums before posting. F Tessa, Debra, Brandi and many others have posted answers to the same questions repeatedly.

    Thanks to all for sharing your vast knowledge!

  5. #5
    Join Date
    Apr 2007
    Hartford, CT


    If you need this in writing, it is on page 4 of the CPT Professional Edition and it is also in the Medicare Evaluation and Management Services Guide. CPT even tells you what they consider "professional services".

  6. #6


    I would think if you are irritated by the question you should just move on and not answer. The person asking this question is NEW and is learning. You could have pointed her to the guidelines as dclark7 did.

  7. #7
    Join Date
    Apr 2007


    Quote Originally Posted by Deb2009 View Post
    I would think if you are irritated by the question you should just move on and not answer. The person asking this question is NEW and is learning. You could have pointed her to the guidelines as dclark7 did.
    I understand Tessa Bartels but I also agree that whoever does not want to give answers to duplicate qestions should just skip them.

  8. #8
    Join Date
    Apr 2007
    Dover Seacoast New Hampshire


    In all fairness to Tessa and other very experienced coders on this board...it's very discouraging to see these basic questions pop up daily....

    A good coder who wants to be an outstanding coder knows how to do the research by reading CPT, checking with CMS, calling the payers, obtaining membership in the professional associations of your medical specialty, and at the very least....first searching the board.

    One of the coders who helped train me had some wonderful words of advice.....
    "Look it up. You'll remember it if you do".
    Pam Brooks, MHA, CPC, PCS, COC
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  9. #9


    I agree with Pam. The person who trained me did the same thing. Would not give me the answer but pointed me in the direction to find the answer.

    Again, that is what I said she could have pointed the person asking the question in the right direction.

  10. #10


    Deb, I agree, if you are irritated by the question dont answer, it was nice to point out the correct area to find the information to the original question as well. I dont think anyone might want to discourage someone from asking a question on one of these boards, even if the same question is asked a thousand times, there may be something new to share or something that has changed that someone can add.

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