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NP vs Est Problem

Jamie Posted Sun 08th of September, 2019 20:50:36 PM
Just wanted to clarify when coding E/M for MDM, is it considered a new problem if it is new to the clinic or provider? Thank you
SuperCoder Answered Mon 09th of September, 2019 04:05:30 AM

Hi Jamie,


A new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice within the past three years.


Sharing an example:


If patient sees Provider A (specialty General Medicine) for the first time but has been seen by the same specialty physician Provider B within the same group practice, then even though the patient is seeing Provider A for the first time, it would be considered an Established visit, not a new one since patient has already been seen by the same specialty physician within the same group with in the last 3 years.


Hope provided information would be helpful.




Jamie Posted Mon 09th of September, 2019 14:56:20 PM
So the original questions was related to the MDM when coding E/M levels. You have options for an Established Problem vs New Problem, I just wanted to know if it is considered a new problem if it is new to the clinic or provider? For example: Pt was to see provider A for Sinusitis(new problem), then next day see Provider B for Sinusitis(at the same clinic) do you count this as an established problem because its established at the clinic or is is a new problem because they are seeing a diff provider they haven't seen before for sinusitis?
SuperCoder Answered Tue 10th of September, 2019 07:45:23 AM

Hi Jamie,


Thank you for the follow up.


If same specialty provider from the same group practice is seeing the patient for the same problem (Sinusitis), it would be considered an established visit since doctor of same specialty and from the same group has already addressed to the condition of the patient day before. Had the patient visited doctor of some different group practice (different facility/location) for the same problem, it would had been considered a New Patient visit for that doctor.


Hope provided information would be helpful.



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