These dilemmas are encountered by physician practices every day and they continue to cause confusion and errors in reporting the encounters.

Current Procedural Terminology (CPT®) makes a distinction between new and established patients for encounters that take place in an office or outpatient facility (99201–99205, 99381–99385); in a nursing facility (99304–99306); in a domiciliary, rest home, or custodial care setting (99324– 99328); and at home (99341–99345). CPT does not distinguish between new and established patients for encounters that occur in the hospital (inpatient, observation, or emergency department) or for consultations performed in the office or hospital.

A new patient is defined by CPT as “one who has not received any face-to-face professional service from the physician, or another physician of the same specialty who belongs to the same group practice, within the past 3 years.” Note that the definition refers to any...

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