Definition of "New and Established Patients" and "Chief Complaint" in E/M Guidelines

By W. Bruce Milliman, ND, and Eva Miller, ND (AMA - CPT/Editorial Panel/HCPAC, representing the AANP)

Since our last article in the eNews we have had questions arise from members as to what the definition of the components in Evaluation and Management (E/M) Guidelines are. First we will define the difference between a new and established patient (new being the CPT codes 99201-99205 and established being 99211-99215). Second we will go through the definitions of the components of the E/M service to be documented (chief complaint, family history, history of present illness, past history, social history, review of systems, and time). Lastly we will discuss the levels of E/M service and the nature of the presenting problem to help you distinguish the complexity of the visit so you can document and code the visit correctly.

In this article we will define the difference between a new and an established patient and the chief complaint.

New and Established patients
As written in CPT Professional Edition
“A new patient is one who has not received any professional service from the physician or another physician of the same specialty who belongs to the same group practice, within the last 3 years. An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the last 3 years.” In the instance when a patient is seeing a covering physician the patients encounter is to be classified as it would have by the physician who is not available.

Chief Complaint
As written in CPT professional Edition
“A chief complaint is a concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” The chief complaint is written in the subjective section of your chart notes.
 
Stay tuned next month for a more in depth discussion on the rest of the components of E/M listed above.