Established Patient Follows Provider to New Clinic

Note: For a new Medicare FQHC patient, see – Medicare FQHC Patients Follow Provider to New FQHC.

Q:

I have a new provider and several of her patients have followed her to our clinic.  Should these patients be coded as new or established at their initial visit in our clinic? 

A:

This question was answered in a CPT Assistant newsletter in which we are reminded of CPT’s new patient definition. The decision is based on whether the patient received professional services from the provider within the past three years, regardless of place of service.  Therefore, if the patient has received professional services from the same physician within the previous three years, the patient should be considered established even though the patient is new to the clinic/group. 

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