tci Medicare Compliance & Reimbursement - 2013 Issue 10

Compliance: Make Distinguishing Between New vs. Established Patient a Breeze

Tip: Keep track of timelines. Evaluation and management of a patient differs depending on whether your physician is seeing a new or an established patient. And the 3-year rule only complicates matters by requiring you to determine whether a patient has been previously seen by another provider belonging to the same practice and specialty in the last three years. See what the experts have to say about when you will need to code 99211-99215 (Office or other outpatient visit for theevaluation and management of an established patient …) rather than 99201-99205 (Office or otheroutpatient visit for the evaluation...

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