A patient returns to a multi-specialty group and sees a physician of the same specialty and same group who treated the patient 18 months ago. For office E/M, how should new versus established status be determined?
Select an answer to reveal the explanation.
Short Explanation
Three-year rule is the club membership card: same specialty, same group, face-to-face within three years means established. A new door badge or a new diagnosis line doesn’t reset the clock.
Full Explanation
CPT defines an established patient as one who received a face-to-face service from the physician or another physician of the same specialty and same group within the past three years. A new diagnosis, different suite entrance, or administrative re-registration does not reset new-patient status. Consultation coding is a separate concept from new versus established office status.