decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 10 (October)
Test yourself: New vs. established patients
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Article Overview
This brief article presents a coding scenario focused on evaluation and management patient status in a multi-specialty practice. It explains the general CMS framework used to distinguish new from established patients and notes why the specialty relationship matters for billing decisions. The piece is aimed at coders, billers, and practice staff who need a quick check on E/M patient classification rules.
Why This Topic Matters
Correctly identifying new versus established patient status affects E/M claim selection and helps practices apply payer rules consistently when physicians in different specialties see the same patient.
Article Sections
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Billing scenario
A brief case-style example involving hospital-based anesthesia and office-based pain management in the same practice. The section frames the patient-status question for an E/M billing decision.
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Answer to 'Test yourself'
The article identifies the correct general patient-status outcome for the scenario and cites CMS policy language supporting the distinction. It also notes how payer specialty information is used in the determination.
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Official resource
A source reference to CMS manual guidance is provided for further review. The section points readers to the applicable manual chapter and section.
What You Will Learn
- How E/M patient status is generally evaluated in a multi-specialty practice
- Why physician specialty information can affect new versus established patient classification
- Where to find the CMS manual reference supporting the guidance
- How a brief billing scenario can be used to test understanding of patient status rules
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Compliance staff
- Anesthesiology practices
- Pain management practices
Codes Discussed
Code Ranges Discussed
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