PART B MYTHBUSTER: Keep Physician Specialty in Mind When Determining New vs. Established Patient Status

Why This Topic Matters

Correct patient status affects whether a visit is treated as a new or established patient encounter, which is a foundational step in selecting the appropriate evaluation and management service category. The article is relevant for practices with multiple clinicians, multispecialty groups, and physicians whose billed specialty may differ from their clinical practice area.

Article Sections

1. But 3-year rule applies in most other situations

   Introduces the article’s main myth-versus-reality framing and discusses the general Medicare framework for determining patient status over a three-year period.

2. Exception for different specialties within the same practice

   Explains the broad exception involving physicians of different specialties and references guidance from CPT Assistant and practice-based scenarios.

3. Potential snag: Specialty designation and Medicare credentialing

   Addresses issues that can arise when a physician’s Medicare specialty designation does not match the specialty under which services are actually performed.

4. Example involving multispecialty practice billing

   Presents a broad scenario involving multiple specialties within one practice and Medicare specialty registration considerations.

5. Tip: New physician and prior services before joining the practice

   Notes that prior professional services provided before joining a practice can affect patient status under the same general framework.