decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 11 (November)
Is a “new” patient really an “old” one?
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Article Overview
This article reviews the rules used to determine whether a patient is considered new or established for evaluation and management reporting. It is aimed at coders, billing staff, and practice administrators who need to apply CPT-based definitions consistently with Medicare guidance, especially in group practice settings where prior visits by physicians in the same specialty can affect patient status.
Why This Topic Matters
Correctly identifying new versus established patient status affects whether an evaluation and management service is reported appropriately. The topic is especially important in group practices and multispecialty settings, where prior encounters may not be obvious to the person coding the current visit.
What You Will Learn
- How new and established patient status is defined for evaluation and management reporting
- Why prior encounters within a group practice can affect patient classification
- How multispecialty group practice situations are treated at a high level
- Where to find the Medicare resource referenced in the article
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance staff
- Physician office staff
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