Would it be appropriate to bill a patient as "New" if a physician changes practices and sees a patient that he/she had previously seen within the past three years while working for another medical group? The physician would not have access to the old medical records unless he/she requested them form the previous medical group. ...
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Article Overview
This brief coding guidance article explains a common evaluation and management scenario involving provider transitions between medical groups. It is intended for coders, billers, and practice staff who need to understand how patient status is assessed in relation to prior professional services and the timing of care.
Why This Topic Matters
Correctly identifying whether a patient is treated as new or established affects evaluation and management code selection and helps avoid coding errors when physicians move between practices.
What You Will Learn
- How patient status is considered in an evaluation and management context
- Why prior physician-patient interactions matter when a physician changes practice settings
- How the timing of previous professional services relates to coding classification
- What factors are relevant when records are or are not immediately available
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician office staff
- Revenue cycle professionals
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