decisionhealth Newsletters, Part B News - 2017 Issue 6 (June)
Beef up exam elements, avoid specialty confusion for new-patient success
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Article Overview
This piece explains why new-patient evaluation and management claims can be denied when documentation or patient-status assumptions do not align with Medicare and CPT expectations. It is aimed at coders, billers, physicians, and front-office staff who support office visit coding, and it focuses on general documentation topics, patient classification issues, specialty identification, and references to CMS E/M guidance.
Why This Topic Matters
New-patient E/M claims are a common source of denials when documentation is incomplete or when a patient is incorrectly treated as new instead of established. Understanding the article helps coding and billing teams reduce avoidable disputes and align workflow with current E/M and Medicare rules.
Article Sections
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Coding
Introduces the article’s focus on new-patient evaluation and management coding and the general denial concerns associated with these visits.
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Implement tips for success
Covers workflow and enrollment-related issues that can affect whether a patient is considered new, including practice specialty information and communication between staff roles.
What You Will Learn
- How new-patient E/M documentation is evaluated at a high level
- Why exam completeness can affect claim outcomes
- How patient status and practice specialty information can influence claim processing
- Why coordination between front desk staff and coding teams matters
- What CMS and CPT guidance are referenced in relation to new-patient office visits
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Practice managers
- Front office staff
- Compliance staff
Codes Discussed
Code Ranges Discussed
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