We are an FQHC (Federally Qualified Health Center) Health Department with the following departments: Behavioral Health, Medical, Reproductive Health, and OB. Providers from the privately owned OB clinic here in town come to our facility and see OB patients 2 days a week.
My question is this: if a patient sees Dr. AZ at that doctor’s clinic, and then decides to come to our facility because the care is cheaper, is the patient’s initial visit in our facility a new patient visit, even though they’ve seen Dr. AZ for care?
The Tax ID & facility NPI numbers are going to be different on the claim. The only similarity is the provider’s NPI number.

So, here would be the scenario:
Patient 12345 seeing Dr. AZ for OB care who has his own provider NPI number
Dr. AZ’s clinic has their own Tax ID & facility NPI numbers
Our facility OB clinic has our own Tax ID & facility NPI numbers
Patient sees Dr. AZ initially at his clinic in September
Now patient sees Dr. AZ in our facility OB clinic in October
Is Patient 12345’s visit with us in October a new patient visit, or an established patient?

The CPT book states: "a new pt is one who has not rec’d any professional svcs 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. And that "an established pt is one who has rec’d professional svcs 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."

To me, according to the CPT book description above, I’d say that the patient’s visit with Dr. AZ in our facility would be considered a new patient. However, another person in our facility that I’ve posed this question to states that just because the patient is new to our clinic does not mean that they’re new to the provider. My argument to that is that the provider is the same, but the group practice is different.
Another example would be a new provider starting & seeing patients at our facility bringing his established patients from a previous practice he belonged to. She is stating that those patients would not be billed as new patients in our facility. I say they’re new patients, and my argument to that is because they are new patients to our facility, which is different than the practice the provider previously belonged to.

Thank you very much for any guidance anyone can provide!!

Marty L., CPC
10/21/2016