E/M Coding Alert - 2010 Issue 19
Reader Questions: Face Time Is Essential to Established Patient
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Article Overview
This reader Q&A addresses a common evaluation and management coding issue: determining whether a patient should be considered new or established after a referral-related service performed without a face-to-face encounter. It is aimed at coders, billers, and practice staff who need to apply general AMA patient-status guidance in physician office settings. The article discusses broad topics such as prior encounters, group billing relationships, specialty considerations, and the timing rules that affect patient classification.
Why This Topic Matters
Patient-status classification affects E/M code selection and can influence how encounters are reported in routine office billing. Understanding the general rule set helps practices apply consistent coding policies when multiple clinicians, specialties, or prior non-face-to-face services are involved.
Article Sections
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Question
Introduces a coding question about patient status after a referral-related test performed by staff when the specialist was not present.
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Answer
Summarizes the general guidance on new versus established patient status and references timing, practice structure, and specialty-related considerations.
What You Will Learn
- How patient status is generally determined in evaluation and management coding
- How prior encounters within a practice can affect new versus established classification
- How specialty and group billing relationships can factor into patient-status review
- How the article frames time-based considerations for office visit coding
Who Should Read This
- Medical coders
- Billing staff
- Physician office staff
- Compliance and revenue cycle professionals
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