New patient or not?

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October 18, 2018

Question:
One of our providers serves as a team physician for a local high school. I was wondering how to report services if he sees an athlete on the sideline for an injury and then the athlete is seen later for the same or a new problem by him or another member of our group within a three year time period.  No CPT code or bill was generated for services on the field. Is it a new patient visit or an established patient visit when the patient is seen in the office?

Answer:
I am sure many share your question with football season in full swing!

The definition of a new patient visit is one who has not received any professional services from the physician or qualified health care professional in the same group of the same specialty in the past 3 years. The definition of “professional service” from CPT Assistant August 2009 states that “professional services are those face-to face services rendered by physicians and other qualified health care professionals and reported by a specific CPT code.” The service on the field generates no CPT code or bill so when the patient is seen in the office it would be reported as a new patient visit.

*This response is based on the best information available as of 10/18/18.

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