Medicare Compliance & Reimbursement - 2020 Issue 7
Reader Questions: Know This New Practice, New Patient Rule
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Article Overview
This article explains a common evaluation and management (E/M) question about patient status when a physician changes practices or starts a new one. It is aimed at coders and billing staff who need a general understanding of how prior patient encounters, group practice context, and timing relate to visit classification. The discussion is focused on practical interpretation guidance rather than on broader policy changes or code-specific updates.
Why This Topic Matters
Correctly distinguishing new versus established patient status affects E/M reporting and supports consistent billing when patients return after a prior visit, even if the physician’s practice setting has changed.
What You Will Learn
- How a change in practice location can affect E/M patient status questions
- How prior patient encounters within a time window relate to visit classification
- How group practice and specialty context factor into patient status determinations
- What general factors are considered when distinguishing new versus established patients
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician offices
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