RevolutionEHR Insights ™

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Doc/Coding tips

New vs. Established Patients
Posted: June 5, 2018

For coding purposes, a new patient is one that hasn’t been seen by you or any other OD in the practice within the last 3 years.  That means if you’re seeing a patient you last saw 5 years ago and that patient hasn’t seen another OD in the practice within that time frame, you’re entitled to use “new” patient codes on the claim.  And that’s significant because “new” patient codes often reimburse better than “established” based on the idea that more time is required to document/update the patient’s history, etc.

So, if you’re seeing a patient that you’ve seen before but she meets the coding definition of a “new” patient, it’s proper to use a “new” patient code for the office visit.





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