In E/M coding, how is a "new patient" defined?

A "new patient" in the context of Evaluation and Management (E/M) coding is defined as a patient who has not received professional services from the physician or the physician’s group within the past three years. This definition is essential for determining the level of care provided and the appropriate coding for reimbursement purposes.

When a patient has not been seen by the physician or the physician’s group during this time frame, they are considered new, which can warrant a different coding structure compared to established patients. This distinction is important because new patients often require a more comprehensive evaluation due to their unfamiliarity with the clinician and the system, which is reflected in the coding guidelines.

In contrast, the other choices do not accurately reflect the official definition. For example, merely moving to a different area does not change the patient’s status if they have previously received services from the same provider. Similarly, if a patient received services within the last year, they are not considered new. Lastly, returning for a follow-up appointment indicates an established relationship with the provider, thus not qualifying them as a new patient.