decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 3 (March)
Everything old is new again
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Article Overview
This article discusses how patient status is determined for evaluation and management reporting when a patient has been seen previously by physicians in the same group. It focuses on the relationship between specialty, group practice, and the three-year lookback period, and it notes how Medicare aligns with CPT guidance and specialty distinction through provider taxonomy. The piece is relevant for coding staff, billing managers, and physician practices that need to classify encounters consistently.
Why This Topic Matters
Correctly identifying patient status affects E/M reporting and is a common source of billing inconsistency in multi-specialty practices. Understanding how group membership and specialty distinctions are considered helps practices apply the same rules across locations and providers.
What You Will Learn
- How patient status is defined in a multi-specialty group practice setting
- How prior care by physicians of the same or different specialty affects classification
- How CPT and Medicare guidance are aligned on patient status
- How specialty distinctions are identified in provider taxonomy concepts
Who Should Read This
- Coding managers
- Medical coders
- Billing staff
- Physician practice administrators
- Compliance staff
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