Ophthalmic Coding Specialist Practice Test

Question: 1 / 400

What distinguishes "new patient" codes from "established patient" codes in ophthalmology?

New patient codes are for patients who have not seen the provider in over a year

New patient codes are for patients who have not received care from the provider in the past three years

The statement that new patient codes are for patients who have not received care from the provider in the past three years accurately reflects the guidelines established by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). In ophthalmology, as well as in other medical specialties, a “new patient” is defined as one who has not been seen by the same provider or the same specialty within a specified timeframe, which is typically three years. This time period is crucial as it helps in determining the patient's status and their medical history with that particular provider.

Understanding the distinction is important for proper coding and billing practices, as using the correct code can affect reimbursements and patient care records. This is why this choice stands out as the correct distinction regarding new patient codes compared to established patient codes.

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New patient codes apply only to children and adolescents

New patient codes are for any patient receiving their first eye exam

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