A new patient is defined as which of the following?

A new patient is defined as which of the following?

• A. One who has not visited the physician in more than 3 years
• B. A patient who has visited the physician within the last year
• C. A patient with a chronic illness
• D. A patient who is aged 65 or older

Answer: (A)

The concept being tested is how to determine if a patient is new or established for billing purposes. New patient status is assigned when the patient has not received professional services from the physician or from another physician of the same specialty in the same group practice within the past three years. So the statement describing a patient who has not visited the physician in more than three years fits this rule, making it the best choice. If a patient has had a visit within the last year, they would be considered established with that physician, and a chronic illness or the patient’s age do not define new versus established. This distinction matters because it affects the required documentation and the level of E/M coding used.

The concept being tested is how to determine if a patient is new or established for billing purposes. New patient status is assigned when the patient has not received professional services from the physician or from another physician of the same specialty in the same group practice within the past three years. So the statement describing a patient who has not visited the physician in more than three years fits this rule, making it the best choice. If a patient has had a visit within the last year, they would be considered established with that physician, and a chronic illness or the patient’s age do not define new versus established. This distinction matters because it affects the required documentation and the level of E/M coding used.