E/M update: Navigate new vs. established patient distinctions during COVID-19

Why This Topic Matters

Accurate patient-status reporting can affect claim handling, internal review processes, and revenue integrity during and after temporary public health emergency policies. The article helps readers understand the scope of the telehealth-related flexibilities and the broader compliance context in which they applied.

Article Sections

1. COVID-19 public health emergency context

   Introduces the temporary policy environment and the article’s focus on new versus established patient status. It frames the issue in relation to CMS guidance during the public health emergency.

2. CMS definition of a new patient

   Summarizes the Medicare framework used to distinguish patient status under CMS policy. It cites the source manual referenced in the article.

3. Telehealth flexibility for established-patient services

   Describes how temporary enforcement discretion affected selected virtual evaluation and management services. It also notes the operational implications for practices using those services during the emergency period.

4. Examples of established-patient specific codes

   Lists several service types discussed by the article as examples tied to established-patient language. The section is presented as part of the article’s telehealth coding discussion.

5. Internal tracking and audit considerations

   Covers the article’s compliance-oriented discussion of using internal claim flags and preparing for later review. It emphasizes operational recordkeeping rather than coding detail.

6. New vs. established matters for telehealth

   Explains the article’s broader telehealth context for services with separate new and established patient categories. It connects patient status to reporting and reimbursement considerations.

7. Telehealth service categories during the PHE

   Summarizes the service groups discussed as affected by temporary telehealth policy changes. It also notes the article’s discussion of differing availability by setting and patient type.

8. Expiration of temporary telehealth coverage

   Notes the article’s discussion of how temporary coverage changes were tied to the public health emergency timeline. It includes the general transition back to normal telehealth requirements.

9. Resource

   Provides the referenced CMS manual resource mentioned at the end of the article.