General Surgery Coding Alert - 2015 Issue 7
You Be the Coder: Specialty Designation Matters in New vs. Established
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Article Overview
This article addresses a common evaluation and management coding question about whether a patient should be treated as new or established for a later office visit after prior care within the same practice. It discusses the role of specialty, subspecialty, group practice, and the time window used in patient status determination, and it is aimed at coders and billing staff who need to apply payer-facing patient classification guidance.
Why This Topic Matters
Correctly identifying patient status affects E/M code selection for office and outpatient visits and helps practices apply specialty-based rules consistently across providers in the same group.
What You Will Learn
- How patient status is evaluated across visits within a group practice
- How specialty and subspecialty can affect patient classification
- Why prior professional services and timing matter in office/outpatient E/M coding
- What to consider when payer rules differ from general patient status guidance
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Practice managers
- Physician office staff
Codes Discussed
Code Ranges Discussed
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