tci E/M Coding Alert - 2018 Issue 1
You Be the Coder: New or Established? It's Not Simply About the Three-Year Rule
Question: What is the difference between a new and established patient when reporting evaluation and management (E/M) services? Indiana Subscriber Answer: You'll code for new patients with CPT® codes 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) through 99205 (... a comprehensive history; a comprehensive examination; medical decision making of high complexity ...), depending on encounter specifics. For established patient E/Ms, you'll choose from the 99211 (Office or other outpatient visit for the...
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