Print | Bookmark | Email | Font Size: + | – Show July 19, 2016 CGS is seeing an increase in the number of questions regarding the difference between a "new" patient vs an "established" patient, to clarify: The American Medical Association (AMA) states:
CMS Publication 100-04, Chapter 12, Section 30.6.7 of the Medicare Claims Processing Manual
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However, the CMS has different definitions of new and established patients in the Medicare Claims Processing Manual, Chapter 12—Physician/Nonphysician Practitioners, Section 30.6.7:
Understanding the three components and awareness of the rules are necessary to bill for new patients. Let’s take a look at each component: What is the rule for coding a new patient visit?Three-year rule: The general rule to determine if a patient is new” is that a previous, face-to-face service (if any) must have occurred at least three years from the date of service. Some payers may have different guidelines, such as using the month of their previous visit, instead of the day.
What qualifies as a new patient visit?By CPT definition, 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.” By contrast, an established patient has received professional services from the physician or ...
How often can you bill CPT 99204?A maximum of 1 unit of 99204 can be billed on the same day by the Same Physician or 2 units can be billed for unavoidable circumstances with proper medical documentation support on a given date.
What is the difference between a new patient and an established patient quizlet?A new patient (NP) has not received any services from the provider (or another provider of the same specialty/subspecialty who is a member of the same practice) within the past three years. A returning patient is called an established patient (EP).
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