decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 5 (May)
Your questions answered - Test interp: New patient or established?
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Article Overview
This article explains a Medicare policy question about new versus established patient status when a physician has interpreted a diagnostic test before the first face-to-face visit. It is relevant to coders, billers, and physicians who need to understand how payer policy treats prior non-face-to-face professional services and where to confirm current guidance with Medicare references and local payers.
Why This Topic Matters
Patient status affects evaluation and management coding and claim reporting, so misunderstanding whether prior test interpretation changes status can lead to incorrect E/M selection. The article highlights Medicare policy context and points readers to the official manual for reference.
What You Will Learn
- How Medicare defines new patient status in relation to prior professional services
- What types of prior services are discussed in the context of patient status
- Why payer policy review may still be important for billing decisions
- Where the article points readers for the official Medicare guidance
Who Should Read This
- Medical coders
- Billing staff
- Physicians
- Practice managers
- Compliance staff
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