Medicare Compliance & Reimbursement - 2012 Issue 31
Reader Question: Allergy Injection Reignites 'New Vs. Established' Patient Debate
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Article Overview
This reader Q&A explains a common coding question about whether prior contact with a patient changes new-versus-established patient status for E/M billing. It is aimed at coders, billers, and practice staff who need to understand the general rules discussed by CPT and CMS, including how group practice, specialty, and the three-year lookback factor into patient classification. The article provides broad guidance on the policy framework rather than a detailed coding tutorial.
Why This Topic Matters
Correctly identifying new versus established patient status affects office and outpatient E/M coding and helps practices apply the same rules consistently across physicians and specialties.
What You Will Learn
- How CPT distinguishes new and established patients in office and outpatient E/M coding.
- How the three-year lookback is discussed in relation to patient status.
- How group practice and physician specialty can affect the classification.
- How face-to-face professional services are treated in the general rule context.
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician office staff
- Compliance staff
Codes Discussed
Code Ranges Discussed
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