ED Coding & Reimbursement Alert - 2017 Issue 1
Reader Question: Get New Vs. Established Patient Right Every Time
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Article Overview
This article addresses a common family practice coding question about whether transferred patients should be treated as new or established when a physician joins a clinic under a new tax ID. It explains the general framework used to distinguish patient status and discusses how prior encounters, practice location, and provider specialty affect that determination. The piece is aimed at coders, billing staff, and clinic administrators who need to apply CPT patient-status guidance consistently across settings.
Why This Topic Matters
Correctly identifying patient status affects visit coding and workflow across practices, especially when physicians change locations or join a group. Understanding the scope of the established-patient rule helps reduce inconsistent coding decisions.
What You Will Learn
- How patient status is determined when care transfers to a physician in a different clinic
- How prior face-to-face encounters affect whether a patient is treated as new or established
- How physician specialty and group practice context relate to patient-status classification
- How practice location factors into patient-status determination
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Family practice staff
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