decisionhealth Newsletters, decisionhealth - 2009 Issue 3 (March)
Newborn Care / Established codes may be needed for a newborn's first visit
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Article Overview
This short coding article addresses whether a newborn’s first office visit should be treated as a new or established patient encounter. It is aimed at coders, billers, and clinicians who need a general understanding of how prior professional services and physician-group relationships affect patient status determination across payer types.
Why This Topic Matters
Correctly identifying patient status is a basic step in evaluation and management coding and can affect claim accuracy. The article is relevant when a newborn has already been seen by the physician or group in a prior setting before the first office visit.
What You Will Learn
- How patient relationship history affects new versus established patient status
- Why the place where prior care occurred is not the only factor to consider
- How prior professional services by the same physician group relate to patient status determination
- How the CPT framework defines professional services at a high level
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Practice managers
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