Coding Basics: 'New' or 'Established' Might Matter More Than You Think

Why This Topic Matters

Correctly identifying patient status and matching it to the appropriate E/M category affects code selection across common office, consult, and hospital services. The article is relevant for coders, billers, and providers who document or review E/M encounters.

Article Sections

1. 3-Year Rule Determines Patient Status

   Explains the general framework used to determine whether a patient is new or established and discusses practice-level considerations. Includes references to CMS guidance and examples involving prior encounters within the practice.

2. Exceptions Could Occur for Different Specialties

   Describes how specialty differences within a multi-specialty practice can affect patient status. The section focuses on how service context and specialty separation may alter the classification approach.

3. Service and Patient Status Determine E/M Range

   Covers how patient status and the type of E/M service guide selection of the appropriate CPT range. Includes discussion of office/outpatient and consultation categories.

4. New Patients, Consults Require All 3 Components

   Reviews the documentation components associated with certain E/M services and how they relate to level selection. Also notes CPT clarification affecting multiple service categories.

5. 2 of 3 Will Do for Most Established Visits

   Describes documentation requirements for many established patient services and compares them with other E/M categories. The section also mentions medical necessity and time-based reporting at a high level.