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Identifying a Patient

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Establishing whether a patient is new or established is proving to be a very controversial issue. Every practitioner has his/her way of identifying a patient thus making it difficult for there to be a standard way of determining patients. While new policies define a new patient differently, practitioners who follow the old policies find themselves in a mix not knowing which policies to exactly follow. While the definitions are almost self explanatory, it is not clear to everyone what they precisely mean. A new patient can be defined as one who has never received any medical or other professional care from either the same or a different practitioner but serving in the same capacity or in the same professional group as the initial practitioner for a period of three years (Anderson, 2004, p. 3).

An established patient on the other hand is one who has at one point received medical and other specialized services from the same practitioner or any other practitioner who serves in the same area of expertise or in the same group as the initial practitioner. A patient however qualifies to be called an established patient if his/her consecutive visits fall within three year. If this period exceeds three years, then the patient is treated like a new patient (Anderson, 2004, p. 21).   

Like any other aspect of healthcare service delivery, the distinction between an established and a new patient and providing appropriate coding for them has been complex in the past few years. This distinction is very important in billing and coding in that it helps the practitioners in giving the appropriate codes for established and new patients. One major difference between their codes is that established patients’ codes require the satisfaction of only two key components, exam and medical decisions while the codes for new patients require three components, the two mentioned above plus their medical history since it is not with the physician (Anderson, 2004, p. 3).

Established patients’ codes range between 99211 and 99215 while new patients’ codes range between 99201 and 99205 (Abbey, 2008, p. 157). Appropriate coding therefore enables the patients to achieve accurate compensation and get better healthcare. Correct coding and billing also increases the standards of compliance for both the patients and their physicians (Abbey, 2008, p. 164).

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