A continuing source of confusion for physicians I consult with is whether the patient should be considered “new” or “established.” While the codes for some services don’t distinguish between new and established patients, the codes for office and other outpatient visits (CPT codes 99201-99215) and preventive medicine services (99381-99397) certainly do.
If coding rules followed common sense, this would be easy. You would just have to ask: Have I seen the patient before? Unfortunately, that straightforward approach does not work. According to CPT, a new patient is a patient who has not been seen by that physician or another physician or other qualified health care professional of the same specialty in the same group practice in the past three years.
Here are reminders regarding three areas of particular confusion:
Whether a patient is new or established is not always obvious. But hopefully these reminders will make the task a little less confusing.
— Betsy Nicoletti, a Massachusetts-based coding and billing consultant
Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career.