decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
New vs Established Patients / Anesthesia twist on new vs established patients
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Article Overview
This article discusses CMS guidance on determining new versus established patient status when an anesthesiology encounter occurred before a later office or clinic visit. It is aimed at coding and billing professionals, especially those working with anesthesia, pain management, and evaluation and management services. The article covers the general concept of face-to-face encounters, how prior procedural care may affect patient status, and related documentation and specialty considerations.
Why This Topic Matters
Correctly identifying patient status affects evaluation and management coding, payer compliance, and consistency across related clinical settings. This topic is especially important for organizations that provide both hospital-based anesthesia services and follow-up outpatient care.
What You Will Learn
- How CMS distinguishes between new and established patient status in the context of prior encounters
- Why face-to-face clinical encounters are relevant to patient status determinations
- How anesthesia-related services can be part of the patient-status analysis
- What related evaluation and management topics are connected to this guidance
Who Should Read This
- Medical coders
- Billing specialists
- Compliance staff
- Anesthesia practices
- Pain management clinics
- Evaluation and management auditors
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