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New vs Established patient

  1. #1
    Location
    Nashville, TN
    Posts
    64
    Default New vs Established patient
    Medical Coding Books
    Could someone please clearify the E/M guidelines where if a patient comes in a is seen by a nurse for a flu shot but no E/M service was preformed would that be considered a new patient or when the patient comes in 2 months later for a well man/woman check and that is the first E/M office visit, will that be considered the new patient visit. I understand the guideline states: A new patient is one who has not received any professional service from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years. Do that include Nurse visits also. I have a patient that can in one month for a immunization and the next month for a blood pressure check, than came in for the first office E/M visit.

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I can tell you that in our facility - in your scenario - the patient would be considered "new" when they finally come in to see the provider. The guidelines are clear - A new patient is one who has not received any professional service from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years. It doesn't include lab, nurse visits only, xray only, etc.... when they see the provider for the first time, they are new -

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    I agree with Donna~

    Interpret the phrase “new patient” to mean a patient who has not received any professional services, i.e., evaluation and management (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 three 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.

    http://www.cms.hhs.gov/MLNMattersArt...ads/MM4032.pdf

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