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New patient visits

Kathleen Posted Tue 01st of October, 2013 18:26:16 PM

If a patient has been coming to a practice and receiving cosmetic services from an Aesthician or cosmetic services such as botox from a physician or a midlevel, and then they come to the practice for a medical visit, are they still considered "New" or do they have to be billed as "Established"

SuperCoder Answered Tue 01st of October, 2013 23:37:36 PM

Good Question raised. Let me put forward this query to my senior editor. We will get back soon.


SuperCoder Answered Tue 01st of October, 2013 23:37:36 PM
With Jen
SuperCoder Answered Wed 02nd of October, 2013 05:30:47 AM

CPT defines "An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." "Professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s)," according to CPT E/M guidelines, page 1.

Lab services with no face-to-face service are not considered to determine patient status. If the physician or midlevel reported the patient's cosmetic services with a CPT code, then you should consider the patient established. If a dummy cosmetic service code was used, the physician or midlevel is not considered to have provided professional services per CPT. In this case, you should consider the patient new.

Jen Godreau, CPC, CPMA, CPEDC

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