ED Coding & Reimbursement Alert - 2014 Issue 6
Reader Question: Keep '3 Year Rule' In Mind
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Article Overview
This reader Q&A discusses the three-year new-patient rule in the context of prior services provided by a physician or group practice. It focuses on how different types of prior contact may influence patient status for a later office or outpatient encounter and is useful for coders, billers, and physician practices handling evaluation and management documentation.
Why This Topic Matters
Correctly determining whether a patient is new or established affects E/M code selection and helps practices apply patient-status rules consistently across encounters.
Article Sections
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Question
A billing scenario is presented involving a prior extremity study in one month and a later office return visit the following month.
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Answer
The response discusses how prior professional services and face-to-face contact relate to patient status for a later encounter.
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Example
A brief illustrative situation shows how prior review of test results is considered when classifying a later E/M visit.
What You Will Learn
- How prior physician services can affect new versus established patient status
- How face-to-face contact is relevant to patient classification
- How office and outpatient E/M concepts are discussed in relation to the three-year rule
- Which types of prior services may not change patient designation
Who Should Read This
- Medical coders
- Billing staff
- Physician practice administrators
- General surgeons
- Compliance staff
Codes Discussed
Code Ranges Discussed
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