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 Q&A reviews Medicare policy on patient status when a physician or specialist interprets a diagnostic test before the first face-to-face visit. It is relevant to cardiology, emergency-to-specialty referral workflows, and billing teams that need to understand how payer policy treats prior professional services versus in-person encounters. The article also points readers to the CMS manual source behind the guidance.
Why This Topic Matters
Correctly determining whether a patient is new or established affects evaluation and management billing and can prevent improper claim classification. The article helps coders and billers understand the payer policy framework that distinguishes diagnostic test interpretation from face-to-face professional services.
What You Will Learn
- How Medicare defines new versus established patient status
- Why diagnostic test interpretation is treated differently from face-to-face professional services
- Where to find the CMS source policy for patient status determination
- Why payer verification may still matter for local billing practices
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Cardiology practices
- Physician office staff
- Compliance staff
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