decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 3 (March)
Your questions answered: Test interp - New patient or established?
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Article Overview
This article addresses a common Medicare coding and billing question about whether a prior diagnostic test interpretation changes a patient’s status from new to established. It summarizes the policy context, notes the role of CMS guidance, and is relevant to coders, billers, and physicians who need to understand how pre-visit professional services may affect later E/M reporting.
Why This Topic Matters
Correctly determining new versus established patient status affects E/M billing and helps avoid classification errors when a provider has interpreted a test before seeing the patient in person.
What You Will Learn
- How Medicare distinguishes new patient status from established patient status
- Why a diagnostic test interpretation may not change patient classification
- What types of prior professional services are generally relevant to patient status
- Where to find the CMS policy referenced in the article
Who Should Read This
- Medical coders
- Billers
- Physicians
- Practice managers
- Revenue cycle staff
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