AMA CPT® Assistant - 1999 Issue 6 (June)
New vs. Established Patient (June 1999)
June 1999 pages 8-9 Coding Communication New vs. Established Patient Figure 1: (Clarified) Decision Tree for New vs. Established Patient It's time now for another installment of Back the Basics. This time we discuss how many of the categories of E/M services have subcategories for differentiating new and established patient services. It is very important to learn the definitions of these terms in order to appropriately report the codes within the E/M section. Review of the Definitions A new patient is one who has not received any professional services from the physician, or another physician of the same specialty...
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Article Overview
This June 1999 Coding Communication article reviews the CPT-based concept of new versus established patient status in evaluation and management services. It is aimed at coders, billing staff, and clinicians who need to understand how prior professional services, specialty relationships within a group practice, and practice changes can affect patient classification. The article presents general guidance on definitions, reporting context, and practical considerations without serving as a code-by-code reference.
Why This Topic Matters
Correct patient-status classification affects E/M code selection and helps align reporting with payer expectations. The topic is especially relevant when care occurs across multiple physicians, specialties, or group-practice arrangements.
Article Sections
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June 1999 pages 8-9
Publication and issue information for the article.
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Coding Communication
Editorial context for the article and its place in a coding education series.
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New vs. Established Patient
Overview of the topic, including the role of patient status in E/M service reporting.
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Figure 1: (Clarified) Decision Tree for New vs. Established Patient
A visual decision aid supporting the article’s discussion of patient classification concepts.
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Review of the Definitions
General definitions of new and established patient status and the time-based framework used to distinguish them.
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Professional Services
Discussion of how prior professional services factor into patient status, including services that may occur without a face-to-face encounter.
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Subspecialties
Consideration of specialty and subspecialty relationships within group practices and how those relationships may affect reporting policies.
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Changing Group Practices
Discussion of how physician movement between group practices can affect whether patients are treated as new or established in the new setting.
What You Will Learn
- How the article frames new and established patient concepts in E/M reporting
- Why prior professional services matter when determining patient status
- How group practice and specialty relationships can affect classification
- Why payer policies may vary for specialty and subspecialty arrangements
- How physician practice changes can influence patient classification questions
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physicians
- Practice managers
- Compliance personnel
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