AMA CPT® Assistant - 2014 Issue 8 (August)
Then & Now: Evaluation and Management (E/M) Services Guidelines (August 2014)
August 2014 page 13 Then & Now: Evaluation and Management (E/M) Services Guidelines THEN There have been numerous CPT Assistant articles (eg, August 2009, October 2006, and January 1998) that discussed how to distinguish whether a patient is considered new or established when reporting evaluation and management (E/M) services. These articles provided information to assist the user in determining when a patient visit should be reported as a new patient as opposed to an established patient. The following definitions were applicable before CPT 2012 for reporting new and established patient, as excerpted from the CPT 2011 code set: A...
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Article Overview
This CPT Assistant article explains the evolution of evaluation and management (E/M) guidance for identifying new versus established patients. It compares earlier and revised CPT-era definitions, highlights the role of specialty and subspecialty language, and uses brief scenarios to illustrate how the guidance applies in practice. The article is relevant to coders, billing staff, and clinicians who work with outpatient E/M reporting and patient classification.
Why This Topic Matters
Correctly identifying whether a patient is new or established affects E/M reporting and compliance. The article clarifies how CPT guidance treats same-specialty, subspecialty, and group-practice relationships.
Article Sections
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THEN
Background on earlier CPT guidance for identifying patient status in E/M reporting and the older definitions used before later revisions.
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NOW
Discussion of the revised CPT-era guidance for patient status determination and the expanded terminology introduced in later code sets.
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Examples
Short scenarios showing how the updated guidance is discussed in different specialty and subspecialty settings.
What You Will Learn
- How CPT guidance for E/M patient status changed over time
- What broad factors are considered when distinguishing patient classifications
- How specialty and subspecialty language is addressed in the article
- How the article frames practical examples for E/M reporting
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Qualified health care professionals
- Compliance personnel
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