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Urgent care new patient vs established patient

  1. #1
    Location
    Mobile, Alabama
    Posts
    12
    Default Urgent care new patient vs established patient
    Medical Coding Books
    We are an Urgent Care facility with multiple sites, each site has its own Tax ID# and own Group NPI. We are struggling with the New patient visit vs an Established patient visit.
    Here are a few examples:

    1. Patient comes into location 1 and sees one of our Physicians for the first time we know that is a new patient visit but what if the SAME PATIENT comes into location 3 not for a follow up but for a new problem and sees the same doctor would this be considered a new or established patient visit?

    2. Patient comes into location 1 sees one of the Physicians and then goes to location 3 at a later date and sees a different Physician would this be a New or Established visit?

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by ola123 View Post
    We are an Urgent Care facility with multiple sites, each site has its own Tax ID# and own Group NPI. We are struggling with the New patient visit vs an Established patient visit.
    Here are a few examples:

    1. Patient comes into location 1 and sees one of our Physicians for the first time we know that is a new patient visit but what if the SAME PATIENT comes into location 3 not for a follow up but for a new problem and sees the same doctor would this be considered a new or established patient visit?

    2. Patient comes into location 1 sees one of the Physicians and then goes to location 3 at a later date and sees a different Physician would this be a New or Established visit?
    1. The physicians all have their own NPI numbers as well, so if the patient is seeing the same physician the subseqent visits are established regardless of the site of service, or the type of visit.

    2. New physician and new location equals new patient. But once the patient is established at that location, all subsequent visits are established regardless of the physician.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    A new patient is one who has not been seen by the physician or any physician in that specialty group within the last 3 years.

    An established patient is one who has been seen by the physician within the last 3 yrs.

    So, the NPI or tax ID numbers are not factors in new or established patients, it depends on the specialty of the physician and the last time the patient was seen.

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