Medicare Compliance & Reimbursement - 2006 Issue 12
CPT 2007 ~ Check This Flow Chart Before Deciding on Patient Status
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Article Overview
This article reviews CPT 2007 guidance for determining whether a patient should be treated as new or established for evaluation and management coding. It is relevant to coders, physicians, and compliance staff working in settings such as emergency departments, clinics, urgent care, and hospital-based follow-up care. The discussion focuses on the CPT flow chart, time-based lookback concepts, specialty and group billing considerations, and potential areas where the wording can lead to coding confusion.
Why This Topic Matters
Patient status affects evaluation and management code selection and can influence claim accuracy and reimbursement. Understanding the CPT 2007 guidance helps reduce misclassification and supports consistent reporting across related practice settings.
What You Will Learn
- How CPT 2007 distinguishes between new and established patients for E/M coding
- Why the 36-month lookback period matters in patient status determinations
- How specialty, subspecialty, and group billing factors can affect patient classification
- Why the flow chart language may create ambiguity in some scenarios
- Which practice settings commonly encounter these patient status questions
Who Should Read This
- Medical coders
- Physicians
- Emergency department billing staff
- Clinic and urgent care billing staff
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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