How to indicate the difference between a new and an established patient
Insurance payers want practitioners to be as precise as possible. Did you know that about 10% of claim denials for outpatient office visits occur because providers fail to indicate whether a patient has already visited their office before or not?
The CPT guidebook 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”. Everyone who does not fall into this description is considered an “established” patient.
But why would insurances care about it in the first place?
An initial encounter with a new patient always takes a while. Examining patient’s entire clinical history is not an easy task. While listening to your patient’s endless complaints, you are simultaneously coming up with a treatment scenario in your head. All this definitely takes longer than if you had an appointment with a patient who regularly comes to your office.
Insurance payers understand that, and they pay you more for such initial encounters. In fact, the CPT guidelines require healthcare providers to use different procedure codes when billing for outpatient office visits furnished on new patients. The following procedure codes must be used to report initial patient encounters, depending on their duration:
• 99202 – 15-29 minutes
• 99203 – 30-44 minutes
• 99204 – 45-59 minutes
• 99205 – 60-74 minutes
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