Answer_Book / Evaluation_and_Management_Services / New or established patient Know the answer before you bill

Why This Topic Matters

Accurately identifying patient status affects code selection and payment for E/M services and helps practices avoid billing errors. The article is relevant for anyone responsible for office visit coding, charge capture, or compliance review.

Article Sections

1. Overview of new versus established patient status

   Introduces the distinction used in E/M billing and explains why it affects code selection and payment. It also frames the operational risk for practices that do not track patient status consistently.

2. Medicare definition and interpretive guidance

   Summarizes Medicare guidance on how patient status is determined for professional services and face-to-face encounters. The section focuses on the general policy framework and related examples mentioned in the source.

3. Scenario examples

   Presents practical scenarios illustrating how patient status may be affected by specialties, practice structure, prior encounters, and time elapsed between services. The examples are used to clarify application of the guidance in common office and follow-up situations.