E and M services definition of new patient vs. established patient

The Office of Privacy and Corporate Compliance reminds providers and their office staff of the difference between new and established patient services, according to Evaluation and Management guidelines. These apply to physicians who are (or were) part of a group practice.

A new patient is one who has not been seen during the preceding three years by the provider or a member of the provider’s specialty group. Every provider has a personal and group history with a patient. A patient may be new to Northeast Medical Group, but not to the provider. For example, if the provider was in another group practice before joining NEMG and saw the patient within the preceding three years, he or she cannot be a new patient to that individual provider.