AMA CPT® Assistant - 2012 Issue 3 (March)
Evaluation and Management, New vs Established Patient (March 2012)
March 2012 page 8 Evaluation and Management, New vs Established Patient The December 1998 issue (p 9) of the CPT Assistant provided information for distinguishing between "new" versus "established" patients when reporting evaluation and management services. This information has been updated in the CPT 2012 codebook's Evaluation and Management Services guidelines. THEN Question: Would it be appropriate to bill a patient as "new" if a physician changes practices and sees a patient that he or she had previously seen within the past 3 years while working for another medical group? The physician would not have access to the old...
Subscribe or sign in to view the full article.
Article Overview
This March 2012 CPT Assistant article reviews updated guidance on determining whether a patient is considered new or established for evaluation and management reporting. It is relevant to coders, billers, and compliance staff working with CPT evaluation and management services and physician office or outpatient encounters. The article focuses on how the CPT 2012 guidance addresses prior professional services, practice changes, and physician specialty relationships in a general coding context.
Why This Topic Matters
Correct new-versus-established patient classification affects evaluation and management reporting and is an important part of compliant physician office and outpatient coding. This article helps readers understand the CPT guidance that applies when physicians change practices or when another physician in the same specialty sees the patient.
Article Sections
-
March 2012 page 8
Introductory publication information and the context for the CPT Assistant discussion.
-
Evaluation and Management, New vs Established Patient
The article presents CPT guidance on how patient status is determined for evaluation and management reporting and discusses a practice-change scenario.
-
THEN
A question is posed about patient status when care continues across different practice settings and records are not immediately available.
-
American Medical Association (AMA) Comment
The AMA provides commentary describing the general approach used to classify the patient under the evaluation and management guidelines.
-
NOW
The article notes that the CPT 2012 guidance remains unchanged and applies the updated reporting framework to related scenarios.
-
Figure 1
A supporting figure is referenced to illustrate the topic discussed in the article.
What You Will Learn
- How CPT guidance addresses new versus established patient status
- What general factors are considered in evaluation and management patient classification
- How practice changes can affect patient status determination
- How related physician and specialty relationships are discussed in the CPT 2012 context
Who Should Read This
- Medical coders
- Professional billers
- Compliance staff
- Physician practice managers
- Documentation specialists
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com
