decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 11 (November)
Know a consult vs. a new patient
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Article Overview
This article covers common evaluation and management classification issues in gastroenterology, especially how to distinguish consults from new and established patient visits when a patient returns for a recall procedure or a separate problem is addressed at the same encounter. It discusses the documentation and relationship factors that affect visit type, along with general CPT-based definitions and multispecialty/group practice considerations. The piece is aimed at coders, billers, and clinical office staff who need to understand how visit classification is determined in practice.
Why This Topic Matters
Correctly identifying visit type affects E/M reporting and documentation consistency, especially when patients are seen across different settings, physicians, or specialties.
Article Sections
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Consult criteria
This section outlines the general circumstances that are relevant when determining whether a visit may be considered a consult. It focuses on the roles of the requesting physician, the receiving provider, and documentation expectations.
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New patient vs. established patient
This section explains the general CPT framework used to distinguish new patients from established patients. It addresses the time-based definition and the relationship between prior professional services and current visit status.
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“Professional service” definition
This section discusses the CPT concept used to characterize prior services for patient status purposes. It highlights the type of service relationship that is relevant when determining whether a patient is considered new or established.
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Multispecialty issues
This section covers visit classification considerations in group practices, multiple physicians, and multiple service locations. It discusses how practice structure and prior encounters can affect patient status determination.
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Additional coder resources
This section lists outside resources and references related to consult and patient status topics. It provides links for readers who want additional background information.
What You Will Learn
- How consults are generally distinguished from new patient encounters
- How CPT patient status concepts are applied in GI practice settings
- What documentation and relationship factors are relevant to visit classification
- How group practice and multiple-site arrangements can affect patient status review
- Where to find additional educational resources on consults and new patients
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Clinical documentation staff
- Gastroenterology office personnel
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