Medicare Compliance & Reimbursement - 2021 Issue 12
Reader Questions: Remember This Rule for ‘Established’ Patient Categorization
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Article Overview
This article is a short coding forum answer focused on patient categorization for evaluation and management office/outpatient visits in a group practice setting. It discusses how specialty, subspecialty, taxonomy, and group practice context affect whether a visit is treated as new or established. The piece is relevant to coders, billers, and practice staff who need general guidance on patient status rules under CPT® for multi-provider practices.
Why This Topic Matters
Correctly identifying patient status affects E/M reporting and helps avoid inconsistent billing when multiple clinicians in the same group practice are involved. The article is useful for understanding how specialty distinctions and practice structure can affect coding workflow.
What You Will Learn
- How patient status is considered in a group practice setting
- How specialty and subspecialty distinctions relate to E/M patient categorization
- What broad factors may affect whether a visit is treated as new or established
- How this issue is discussed in the context of office and outpatient E/M services
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physician office staff
- Compliance personnel
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