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Is the Patient New or Old?



For the people in medical coding jobs, it is very critical to distinguish between an established patient and a new patient to code accurately. To do appropriate Evaluation and Management (E/M) coding and adhere to the coding compliance for timely reimbursements, it is necessary to understand the difference between a new patient and an established patient.



Established Patient:
According to the CPT guidelines, a person who has received a professional service from a physician or healthcare professional of the exact same specialty and who belongs to the same group practice, within the past three years is an established patient. For the new entrants into medical coding, it is difficult and confusing to distinguish between an established and new patient, but it is very important to learn this. To understand this better, one has to know what a professional service is. For the purposes of E/M code selection, the CPT recognizes a service as professional service if they are rendered face-to-face by physicians and other qualified healthcare professionals who may report E/M services reported by a specific CPT code. It is to be noted by the people in medical coding jobs that in this context face-to-face nature is very important for a professional service.

New Patient:
According to the CPT guidelines, a person who has not received professional services from a physician or qualified health professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years is a new patient.

A point to be understood by medical coding professionals is that if an insurance claim was submitted or not does not impact the determination of new or established patient. 

To do the best in your medical coding jobs learn the distinction between an established patient and a new patient and use appropriate the E/M codes so that there are no errors and later no insurance claim is rejected or denied showing wrong codes as a reason. In cases where you have a doubt, it is always better to ask your seniors how they deal with such a case. Join Avontix, one of the best medical coding companies in Hyderabad for proper guidance and enviable growth in the career.
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