Health Information Management

Tip: Differentiate between new, established patients when selecting E/M level

APCs Insider, September 10, 2010

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Designating a patient as new or established depends on whether the patient has been registered as an inpatient or outpatient of the hospital or clinic within the past three years. 

An established patient is one who has been registered as an inpatient or outpatient of the hospital within the three years prior to the visit.

A new patient is one who has not been registered as an inpatient or outpatient of the hospital within the three years prior to the visit.

Patients registered as outpatients in a hospital’s off-campus provider-based clinic or ED within the past three years would be considered established patients of the hospital for on-campus or off-campus clinic visits, even if the hospital created their medical records more than three years ago.

As with previous policy, a patient may be new to a physician but established with respect to the hospital. The opposite would be true if the physician has a longstanding relationship with the patient, in which case the patient would be an established patient with respect to the physician and a new patient with respect to the hospital.

This tip is adapted from “Use internal guidelines to ensure consistent E/M coding” in the August issue of Briefings on APCs.



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