tci Medicare Compliance & Reimbursement - 2010 Issue 15
E/M Best Practices: Master New Patient E/Ms or Leave Cash on the Table
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Article Overview
This article explains the practical and financial differences between new and established patient evaluation and management services. It is aimed at coders and medical practice staff who work with office and outpatient E/M reporting and want to understand why new patient coding can matter to revenue and documentation expectations. The discussion focuses on general E/M requirements, comparative reimbursement impact, and the importance of matching the reported service to the patient status.
Why This Topic Matters
Choosing the appropriate E/M category can materially affect payment and help avoid underreporting services in office and outpatient settings.
What You Will Learn
- How new patient and established patient E/M services differ at a high level
- Why patient status can affect reimbursement
- What broad documentation and component expectations are associated with office/outpatient E/M reporting
- How coding choices can influence payment for a visit
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice managers
- Clinicians who document E/M services
Codes Discussed
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