decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 2 (February)
Ask Linda: Interpreting a test prior to new patient visit
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Article Overview
This article discusses Medicare policy on determining new patient status when a physician has previously interpreted a diagnostic test before the first face-to-face visit. It is aimed at coders, billers, and cardiology practices that need to understand payer policy around patient classification and initial evaluation and management services. The article also references historical policy context and points readers to the relevant CMS manual guidance.
Why This Topic Matters
Correctly classifying a patient as new or established affects office visit billing and compliance. This piece helps readers understand the general Medicare policy framework and why payer review may still be appropriate.
What You Will Learn
- How Medicare distinguishes new patient status from established patient status
- How prior diagnostic test interpretation is treated in relation to the first visit
- Why payer policy history may matter when reviewing patient classification
- Where the referenced CMS guidance can be found
Who Should Read This
- Medical coders
- Medical billers
- Cardiology practices
- Revenue cycle staff
- Compliance staff
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