Coding, Classification & Reimbursement

New VS Est Patient Code

  • 1.  New VS Est Patient Code

    Posted 12-11-2018 14:16
    I need help clarifying a situation. We have a family practice physician that joined our pain management group and she is practicing family practice. My question is how would I could her patients that she HAS seen at her previous location in the last 3 years. All of the documentation I can find states that regardless of location , if she has seen the patient in the last 3 years for the same specialty , it is considered a established patient. My office manager reads it different and since it is a new group, they should all be new patients. She also contacted the AOA, because our pain doctor is a DO, and they also stated that it should be NP ?? I called Medicare and BCBS and they informed me established based off the information provided. Am I missing something ??? If so what part am I misreading ?

    Amanda Parmer
    Medical Billing

  • 2.  RE: New VS Est Patient Code

    Posted 12-12-2018 09:10
    ​Any patients the provider has seen previously at her old practice (within 3 years) would be considered established.  The E/M guidelines are pretty clear in this regard.

    Leonta Julien-Williams
    Coding Director

  • 3.  RE: New VS Est Patient Code

    Posted 12-13-2018 09:04

    I agree.



    Kristin Ferriter, MHA, RHIT, CPASRM

    Program Manager Compliance and Risk Management

    It's not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change- Charles Darwin



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    100 Carolina Meadows

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  • 4.  RE: New VS Est Patient Code

    Posted 12-14-2018 18:09
    This is correct

  • 5.  RE: New VS Est Patient Code

    Posted 12-14-2018 19:19
    I thought I was correct , just want to get some other opinions. It was pretty clear to me as well.

    Amanda Parmer