decisionhealth Newsletters, decisionhealth - 2010 Issue 12 (December)
Ask the Expert: New vs. established E/M when covering call for another doctor
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Article Overview
This article discusses evaluation and management visit classification when one physician covers call for another physician outside the usual practice setting. It outlines the relevant guidance from the AMA and CMS, highlights why payer treatment can differ by practice arrangement, and is useful for coders, billers, and practice managers who need to understand how coverage relationships may affect patient status determinations.
Why This Topic Matters
Coverage arrangements can affect how a patient encounter is categorized and how the service is viewed by payers. Understanding the governing guidance helps practices evaluate workflow, reimbursement impact, and compliance considerations when physicians cover for colleagues in other practices.
Article Sections
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Question
Introduces a scenario involving call coverage for another physician and asks how the encounter should be classified for billing purposes.
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Answer
Summarizes the general guidance discussed in the article and notes the organizational sources referenced for patient-visit classification.
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Official resources
Lists the referenced AMA and CMS source materials supporting the discussion.
What You Will Learn
- How call coverage can affect evaluation and management visit classification
- Why patient status may be treated differently depending on practice arrangement
- Which organizations provide the cited guidance on this topic
- How Medicare guidance is referenced in relation to physician group practice settings
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Physicians
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