When is a Patient Considered a “New Patient”

by Steve Adams, CPC, CPC-H, CPC-I

The phrase “new patient” means a patient has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice (same physician specialty) within the previous three years.

For example, if a professional component of a previous procedure is billed in a 3-year time-period, e.g., a lab interpretation is billed and no E/M service or other face-to-face service with the patient is performed, then this patient remains a new patient for the initial visit.

An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.

Beginning in 2012, the AMA CPT instructions for billing new patient visits included physicians in the same specialty and subspecialty. However, for Medicare E/M services the same specialty is determined by the physician’s or practitioner’s primary specialty enrollment in Medicare.

 

Steve Adams, CPC, PCS is a Senior Consultant for InGauge Healthcare Solutions, Inc., an InHealth company.   Contact him for consulting and educational services at steve.adams@ingaugehsi.com.  Efficiency in Practice is the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, Patient Collections: It’s Make or Break for Many Practices, visit www.efficiencyinpractice.com 

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