New vs. Established Patient

CodeCast Podcast - Coding, Reimbursement, and Compliance

This week, Terry discusses the ever confusing topic of “New vs. Established” patient visit.

Billing and coding staff continue to have confusion over the question of “What is a New Patient?” However, it’s not only the billing office that needs clarification but physicians as well. Since new patient visits carry a higher Relative Value Unit (RVU, or “reimbursement”) they are always going to be under the watchful eye of payers.

Those payers are quick to deny any unsubstantiated claims, which means your E/M coding needs to hold up to claims review. Today’s CodeCast will give you the insight and guidelines for review while adding tips for capturing new patient revenue (when appropriate).

Bonus: At the end of the podcast Terry will also give her overview of the CMS listening call from 3/21 and the potential changes coming to the E/M services in 2019 and 2020.

Subscribe and Listen

You can subscribe to our podcasts via:

If you’d like to become a sponsor of the CodeCast podcast please contact us directly for pricing:




    Hi Terry –

    Enjoyed this podcast !
    I work in an Orthopaedic group in Georgia.
    We have 6 Orthopedic Physicians, 1 Physical Medicine & Rehab and 4 PA-Cs.
    We are part of a hospital together with several other Specialty Groups called CHSI (Cooperative Healthcare Services Inc.) CHSI Ortho, CHSI Neuro, CHSI Gastro, etc. all under the same Tax ID but all have different taxonomy IDs and NPIs.
    We are getting New Patient denials even when patient has never been seen by our Ortho docs. Should these be appealed with taxonomy IDs? Thanks for your help with this!

  2. Terry Fletcher says:

    Hi Karen,
    You’re going to find some challenges here all under the same tax ID. The biggest issue is if patients are being referred for a test, procedure or surgery then the MDM was already done by referring physician so a new patient visit would not be supported.
    Thanks for listening in!

Leave a Reply

Email will remain private. All fields are required. No html tags alowed.