decisionhealth Newsletters, Part B News - 2001 Issue 1 (January)
New patient stays new until E/M provided, HCFA says
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Article Overview
This premium article summarizes HCFA guidance for physicians, group practices, and coding staff on Medicare evaluation and management billing. It focuses on how patient status is determined, how to handle multiple same-day E/M services, when time-based selection may apply, and several related billing clarifications involving special service-reporting situations. The article is relevant for office-based practices and coders who need to understand the general categories of guidance issued in the Medicare Carriers Manual update.
Why This Topic Matters
It addresses common E/M billing questions that can affect claim selection, documentation expectations, and compliance with Medicare carrier policy.
Article Sections
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HCFA billing clarification on patient status and same-day E/M services
Introduces the Medicare carrier update and outlines the major topics covered in the clarification. It frames the discussion around patient status, same-day service reporting, and other billing issues.
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Additional E/M billing clarifications
Covers related guidance on time-based service selection, reporting considerations for reduced services, and consultation requests by certain practitioners. This section collects the remaining billing points addressed in the article.
What You Will Learn
- How the article frames Medicare guidance on new and established patient status
- What general issues are discussed for multiple E/M services on the same date
- Which broader billing topics are included in the clarification update
- How the article relates to E/M reporting, time-based selection, and special billing situations
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Compliance personnel
- Practice administrators
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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