tci E/M Coding Alert - 2019 Issue 5

Reader Question: Establish These 3 Rules for New Patient Determination

Question: Our practice was recently audited, and an established patient visit was marked as incorrect because the auditor considered the patient to be new. We had seen the patient within the last three years. Can you explain what could have gone wrong? Georgia Subscriber Answer: A close reading of CPT®’s new and established patient guidelines reveals much more than the simple definition that a new patient is one that has not received services from your practice in three years prior to seeing your provider. CPT® also requires that: 1. The services need to be professional. “Professional&rdquo...

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