We are a Pain Management specialist group, we have a patient who was not seen
for back/neck pain in our office for more than a year now. The patient is coming
back this time with a different condition (knee pain after falling on snow at her
garage 2 weeks ago!). Will this encounter be considered as a New Patient
encounter since it is a different condition and different body part?
The answer is NO, per AMA's CPT guidelines, you can only bill for a New Patient
encounter if -- "A new patient is 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 last 3 years".
So based on this guideline, regardless of any change on the patient's condition, if
she was seen for the last 3 years, this is considered an established patient (which
in this scenario, the last time your visit saw this patient was just a year ago!).
If you need additional information on this guideline, see your CPT code book.
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