Is that patient new?


Fam Pract Manag. 2004 Feb;11(2):17.

To the Editor:

I recently read Emily Hill’s “Understanding When to Use the New Patient E/M Codes” [September 2003, page 33]. I work for a physician with an established private practice, but he occasionally works in an urgent care clinic and bills under the clinic’s tax identification number for patients he sees there. If he sees a patient at the clinic who then comes to the private practice, should our practice submit a new patient code or an established visit code?

Author’s response:

The CPT definition of a new patient is “one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years.” The key word in the CPT definition is “or.” If an individual physician provides professional services to a patient, in any location, within a three-year period, the evaluation and management (E/M) services are reported using established patient visit codes (99211-99215). The issues of specialty and group tax identification numbers apply only when the patient sees another physician in the same group.


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