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New Patient vs established with new provider

Susan Posted Tue 20th of August, 2019 10:44:02 AM
Provider has joined our group and she has her established patients now coming to see her at new group. Should her established patients be scheduled as established or new since she is with a new practice? Are we correct in having these patients fill out new paper work since it is a different group?
SuperCoder Answered Wed 21st of August, 2019 03:21:57 AM



Thanks for the question.


You would consider the new provider’s patients established.

CPT defines an established patient as one who has received professional (face-to-face) services from the physician/qualified healthcare professional or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 36 months (three years).

If the provider treats a patient during a face-to-face service within the previous three years (in any location), that patient is established (in all locations). Where the patient is seen doesn’t matter. This includes patients who are first seen in the hospital. When arriving to the office, they are also established patients. Also, because the patient is considered established to your new physician, that patient is considered established to all the physicians in his new practice who are of the same specialty and subspecialty.


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Hope this helps.




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