A new patient is defined as someone who

• A. One who has moved to a new practice
• B. One who has a different payer
• C. One who has not received care from the provider or another provider in the same specialty within the same practice in the past 3 years
• D. One who has received care from the provider or another provider in the same specialty within the same practice in the past 3 years

Answer: (C)

In medical practice, whether a patient is new or established depends on prior encounters with the same provider or the same practice and specialty. A new patient is someone who has not received professional services from the provider or from any other provider in the same specialty within the same practice in the past three years. If they have had care within that three-year window, they’re considered established.

This matters because new vs established status guides coding and documentation expectations for visits. The other options don’t define new patient status: simply moving to a new practice or having a different payer isn’t what determines it, and having care within the past three years would make the patient established rather than new.