ED Coding & Reimbursement Alert - 2020 Issue 6
Reader Question: Does New Practice Nix Established Patient?
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Article Overview
This short coding Q&A addresses evaluation and management patient status questions in the context of a physician changing practices or group settings. It is aimed at coders, billers, and practice staff who need to understand the general guidance behind patient classification and how prior encounters within a group may affect that determination. The article focuses on the broader policy considerations and time-based context used in this type of scenario.
Why This Topic Matters
Patient status affects E/M reporting and can influence workflow, claims handling, and consistency across a group practice. Understanding the general rule helps coding staff apply the article’s guidance correctly in situations where a clinician changes locations or organizations.
What You Will Learn
- How patient status is discussed in E/M coding scenarios involving a change in practice setting.
- How prior encounter history within a group practice is relevant to patient classification.
- Why location alone is not the only factor considered in this type of question.
- How a time-based lookback period is part of the discussion.
Who Should Read This
- Medical coders
- Billers
- Practice managers
- Revenue cycle staff
- Physician office staff
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