Recently, a new physician of a different specialty joined our practice. Several of her previous patients are now coming to this office, and we are wondering whether these patients will be considered new or established when she sees them for the first time in this practice. Can you please clarify? ...
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Article Overview
This short coding guidance article addresses whether patients should be treated as new or established when a physician of a different specialty joins a practice and encounters patients from a prior setting. It is aimed at medical coders, billers, and practice staff who need help applying patient-status rules in a group practice context and understanding the time-based lookback concept discussed in the article.
Why This Topic Matters
Patient status affects evaluation and management coding and can influence how visits are reported in the new practice environment.
What You Will Learn
- How patient status is determined in a group practice setting
- How prior professional services and specialty affiliation affect whether a patient is considered new
- How the article’s practice-transfer example illustrates the general rule for first-time visits in a new office context
- The relevance of a 3-year lookback period in patient-status determination
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Front office staff
- Physician office staff
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