ED Coding & Reimbursement Alert - 2004 Issue 11
Reader Questions: New Medical Record Doesn't Mean New Patient
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Article Overview
This short coding Q&A addresses CPT office visit patient-status classification in a group practice setting. It is aimed at coders, billers, and practice staff who need to understand how prior professional services affect whether a visit is considered new or established, and why medical record creation alone does not determine the category. The article gives a practical clarification of the general guidance and references the relevant CPT office visit code families.
Why This Topic Matters
Correctly distinguishing new versus established patient visits affects office visit code selection and helps avoid misclassification when patients are seen by different physicians in the same group.
What You Will Learn
- How patient status is evaluated in a group practice context
- Why medical record creation is not the deciding factor for office visit classification
- How prior professional services influence office visit category selection
- Which general CPT office visit code families are implicated in the discussion
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office staff
Codes Discussed
Code Ranges Discussed
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