New versus Established and Change of Tax ID#

[Charlene]

Hello,

We have an internal debate going on the rules for New versus Established patient specifically for patients following a provider from one local clinic to another local clinic within the 3yr period (same rendering provider NPI with different Group Tax ID numbers).

In this situation; would the patient be considered "New"; since they have never been seen at the new Group location ? Or are they Established because they have already seen the provider within the 3yr period ?

Please site the guidelines supporting your response.

Thanks,
Charlene DiGiacomo, COC

[Bill_Wong]

Hi Charlene,

It will be considered established patient, if the patient comes within the 3 years time frame. Here is a Q/A from Noridian. See "Claim Examples 2."

A patient sees Dr. Smith, a cardiologist, for follow up care at "Clinic A."

Date of Service Service Provided CPT Code
06/23/17 Established E/M 99213
Dr. Smith leaves "Clinic A" and joins "Clinic B." The patient follows Dr. Smith to "Clinic B."

Date of Service Service Provided CPT Code
7/15/17 Established E/M 99213
Although Dr. Smith is at a different clinic, the patient is still an established patient with him. Dr. Smith's NPI is used to track if the patient has been seen within the previous 3-years.

I have attached the full article from Noridian's Website. I have also attached their E/M Webinar that states this on slide 14.

Bill

[Charlene]

Thanks Bill..... great information !
Charlene