Ask a Part B News Expert

Why This Topic Matters

Correctly distinguishing among E/M service types and payer policies affects claim accuracy and compliance. This topic is especially important when a patient has prior encounters with the same physician across different care settings.

Article Sections

1. Question and answer

   Introduces a billing scenario involving a patient seen in both office and hospital settings and addresses how the issue differs by payer type.

2. E/M service categories and patient status concepts

   Reviews the broader outpatient and facility-based E/M service groups discussed in connection with new and established patient concepts.

3. Medicare and private payer considerations

   Summarizes the article’s discussion of how payer policy can affect the choice of service category in similar encounter patterns.

4. Reference and submission information

   Provides a cited Medicare manual reference and contact information for submitting future questions.