Coding Corner Answer – New Patient vs. Established Patient Quiz

Take the challenge…

1. A: Established. Even though Dr. Raven is now practicing at a new location, the patient is considered an established patient because she received professional services from Dr. Raven within the past three years. The CPT manual defines a new patient as “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.”

2. A: Established. Even if the patient has never seen another rheumatologist, the patient was seen within the last three years by another physician of the same specialty who currently works in that practice.

3. B: New. If a patient has not seen the physician or another physician of the same specialty in that practice within three years, then that patient is considered a new patient.

4. A: Established. The patient was seen three months ago by Dr. Sparrow, so all of Dr. Sparrow’s patients are now considered established to anyone of the same specialty in the practice.

5. B: Established. Even though the patient saw Dr. Dove for the first time in the hospital, the patient is considered an established patient to any physician of the same specialty within that practice.

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