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New pt or established pt?

Randi Posted Wed 23rd of April, 2014 15:59:02 PM

I seen my endocrinology doctor in April of 2013. I called to get an appointment for May of this year and he had changed medical groups. They told me I was a new patient. Is this correct?

SuperCoder Answered Thu 24th of April, 2014 07:47:52 AM

I apologize for the earlier answer stated. The answer is

No,Infact location doesn't matter. The fact that the patient was seen by this provider within the past three years matters. The only time he wouldn't be established is if there was no face-to-face service prior.

You should not use place of service (POS) as an indication of new versus established patient. Based on CPT®’s established patient definition, new versus established refers to the patient’s relationship to the physician, not his relationship to the practice or its location. Practices often think they can bill a patient as "new" because the patient is new to their practice. But remember, the same physician already saw the patient - just in another location.

Because POS is irrelevant to this case, even if the physician saw a patient in a different practice, the next time the provider at the new practice sees that patient he is an established patient.

Even though this patient is new to the office, you should report an established patient office visit (99211-99215), not a new patient E/M service (99201-99205). Because the endocrinologist had a face-to-face visit with the patient in the other office, the patient became an established patient for subsequent E/M encounters.

Thanks to my editor for bringing it to our attention.

Randi Posted Tue 29th of April, 2014 09:24:16 AM

So, although I was seen by him last year, I'm a new patient because he changed groups?

SuperCoder Answered Tue 29th of April, 2014 10:03:35 AM

Please see the explanation above.

Thanks,

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