New Patient CPT Code
New Patient Definition
Before knowing the new patient CPT code let’s understand the definition of a new patient. 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 another physician in the same group and the same specialty within the prior three years. Today, like so many other aspects of health care delivery, differentiating between new and established patients, and coding your services accordingly has become more complex.
- New patient visits require more work than established patient visits at the same level, and this is reflected in the coding requirements as well as the reimbursement for new patient visits.
- A key to differentiating between new and established patients is understanding two terms used in CPT’s definition of a new patient: ‘professional services’ and ‘group practice.’
- Medicare’s definition of a new patient is slightly different than CPT’s.
The distinction between new and established patients applies only to the categories of evaluation and management (E/M) services titled ‘Office or Other Outpatient Services’ and ‘Preventive Medicine Services,’ but as a family physician, most of the codes you submit fall into these categories, and the definition is hard to incorporate into your coding habits.
Office/Outpatient E/M Coding (99202-99215) Changes in 2021
Effective with date of service Jan. 1, 2021, the American Medical Association (AMA), which holds copyright in CPT®, and the Centers for Medicare & Medicaid Services (CMS) implemented major revisions related to office and outpatient E/M codes 99201-99215 in 2021. For complete information regarding all CPT codes and descriptions, refer to the 2021 edition of Current Procedural Terminology, published by the AMA. The stated goals were reducing administrative burden, improving payment accuracy, and updating the code set to reflect current medical practice.
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For detailed new patient CPT code you can refer following blogs
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For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at [email protected]