decisionhealth Newsletters, Part B News - 2019 Issue 8 (August)
For E/M, initial NPP-only visit counts — unless there’s no professional service
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Article Overview
This Find-A-Code article discusses how patient status affects E/M billing when an initial encounter is performed by a non-physician practitioner and a later encounter is performed by a physician. It addresses general concepts tied to professional services, practice relationships, specialty considerations, and the role of payer policy. The article is useful for billers, coders, and office staff who need to understand when a return visit may be considered new versus established in a practice.
Why This Topic Matters
Patient status drives E/M billing category selection, so understanding when an initial NPP encounter counts as the first professional service can affect claim accuracy and compliance. The topic is especially relevant for practices using physician assistants, nurse practitioners, and other non-physician practitioners.
What You Will Learn
- How patient status is evaluated when an initial visit is handled by a non-physician practitioner
- How professional service involvement affects later billing considerations
- How specialty and practice relationships can influence whether a patient is treated as new or established
- How payer policy and time since last visit may affect patient status
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician assistants
- Nurse practitioners
- Compliance staff
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