A patient whose first office visit is with the PA (Physician’s Assistant) trained in Family Practice; his provider taxonomy code is family practice. The patient’s subsequent appointment with the MD (Doctor of Medicine), whose provider taxonomy code is pain management (both providers work in the same practice). Would the 2nd visit be billed as new or established E/M service?

CPT defines “a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years”. For the purpose of determining whether a patient is new or established, CPT considers physician assistants or nurse practitioners to be the same specialty as the physician they work with. So a patient seen for the first time would be established if he or she has previously seen a physician assistant or nurse practitioner in your group. (CPT Guidelines Common to all E/M services-New and Established Patient)