AMA CPT® Assistant - 1998 Issue 8 (August)
Evaluation and Management, On Call Covering (Q&A) (August 1998)
August 1998 page 10a Coding Consultation Evaluation and Management, On Call Covering (Q&A) Question My physician is covering for another physician of the same specialty in the same group practice. If my physician has never provided professional services to the patient, can we code the visit as a new patient visit? AMA Comment In the instance where a physician is on call for or covering for another physician, the patient's encounter is classified as it would have been by the physician who is not available. Therefore, if the patient is an established patient of the physician who is...
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Article Overview
This short coding Q&A article addresses evaluation and management reporting in an on-call or covering-physician situation within the same specialty and group practice. It is aimed at coders, billers, and clinicians who need to understand how coverage arrangements affect visit classification at a high level. The article presents an AMA comment clarifying the general approach to categorizing the encounter when the regular physician is unavailable.
Why This Topic Matters
Coverage arrangements can affect how an encounter is classified for evaluation and management reporting, so this article helps readers recognize the general policy context for same-group, same-specialty call coverage.
What You Will Learn
- How an on-call or covering-physician scenario is addressed in evaluation and management reporting.
- How group practice and specialty context relate to encounter classification.
- What general type of guidance the AMA provided in a 1998 CPT® Assistant Q&A.
- How coverage situations can affect whether a visit is considered in the context of an existing physician-patient relationship.
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Practice managers
- Compliance staff
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