decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 11 (November)
Consultation for returned patient?
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Article Overview
This short coding guidance article discusses evaluation and management visit categorization for a patient returning after prior care, including the role of a referring physician’s documented request for advice and opinion. It is aimed at medical coders and billing staff who need to distinguish consultation, established patient, and new patient scenarios in a urology context.
Why This Topic Matters
Correct visit-type selection affects claim reporting and compliance, especially when a patient returns with a different clinical issue or after prior treatment. The article helps readers understand the broad documentation elements that influence whether a consultation may be appropriate.
What You Will Learn
- How prior treatment history affects visit-type classification
- What role a referring physician’s request plays in determining a consultation
- Why the nature of the presenting problem can matter in visit categorization
- How return visits are generally distinguished from new patient encounters
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Urology practices
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