E/M Coding: Knock Out Questions on New/Established Patient E/M

Why This Topic Matters

Correctly identifying patient status affects claim accuracy and reimbursement. The article matters for practices that bill office and outpatient E/M services, especially when handling patients who were previously seen by the same physician group or when consulting services are being reassigned under current E/M coding concepts.

Article Sections

1. Overview of new versus established patient coding

   Introduces the importance of patient status in E/M reporting and discusses the shift away from consultation-style coding. It frames the article around avoiding common status-related billing errors.

2. Revenue impact of coding status

   Compares the reimbursement impact of reporting different patient-status E/M services. The section explains why the distinction matters to physician practices.

3. The three-year lookback rule

   Explains the general time-based framework used to determine whether a patient is new or established. It includes discussion of prior encounters within the physician or group setting.

4. Face-to-face service requirement

   Covers how prior professional contact is evaluated when determining patient status. It addresses situations where prior non-face-to-face interactions are considered differently from in-person services.

5. Specialty considerations in multispecialty practices

   Discusses how specialty and group structure affect patient classification. It also notes follow-up concerns when a payer disagrees with the reported status.