In CPT coding, what do the terms "new patient" and "established patient" refer to?

In CPT coding, distinguishing between "new patient" and "established patient" is essential for accurate billing and coding. The term "new patient" specifically refers to a patient who has not received any professional services from the provider or the same group practice within the last three years. This classification is important because it typically impacts the complexity and the reimbursement associated with the services provided.

On the other hand, an "established patient" is someone who has been seen by the provider within that three-year timeframe. This classification can affect the coding for office visits, as established patients usually entail a different set of coding guidelines and reimbursement rates due to the familiarity with the patient's history.

Thus, choice C accurately captures the criteria that differentiate between these two types of patients, ensuring that healthcare providers are coding their services appropriately based on the relationships and prior interactions with the patients.