decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 12 (December)
When is a “new” patient really an “old” patient?
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Article Overview
This article covers common evaluation and management billing situations that affect whether a patient is considered new or established. It is aimed at coders, billers, and practice staff who need to apply CPT-based patient status rules in group practice settings, including situations involving prior inpatient and office encounters, multispecialty groups, and Medicare’s alignment with CPT definitions.
Why This Topic Matters
Correctly classifying patient status affects E/M reporting and helps avoid misbilling when a prior encounter occurred within the relevant time period or within the same group practice. The topic is especially important in larger or multispecialty practices where records may be fragmented across settings and physicians.
What You Will Learn
- How patient status is generally determined for evaluation and management reporting
- Why prior encounters within a group practice can affect whether a patient is treated as new or established
- How specialty differences within a multispecialty group can affect patient classification
- Why documentation awareness matters when encounters occur across inpatient and office settings
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians
- Clinical documentation specialists
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