Medicare Compliance & Reimbursement - 2004 Issue 31
Evaluation & Management: When Is A New Problem Not A New Problem?
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Article Overview
This article discusses evaluation and management documentation and billing questions involving whether a condition should be treated as new or established when the patient has been seen elsewhere in the same practice. It summarizes carrier guidance and practitioner commentary on how practice structure, prior records, changing clinical status, and other general factors may affect the level of service. The piece is relevant for physicians, coders, billing staff, and compliance professionals who work with office visit coding and medical decision-making.
Why This Topic Matters
Correctly characterizing whether a problem is new or established can affect evaluation and management level selection, the perceived complexity of the encounter, and how documentation is interpreted across providers in the same organization.
What You Will Learn
- How prior treatment within a practice can affect the way a patient’s problem is viewed for coding purposes.
- Why changes in clinical status and treatment context can influence evaluation and management complexity.
- How practice structure and timing between visits may be relevant to office visit assessment.
- What general factors may contribute to a higher level of medical decision-making.
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
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