Part B Insider - 2013 Issue 1
Clip and Save: Follow this 5-Question Path to Find Out if the Patient is Really New
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Article Overview
This article explains a step-by-step decision path for determining whether a patient should be considered new or established for office or other outpatient evaluation and management services. It is aimed at coders, billers, and clinicians who need to understand the CPT framework, the relevant time window, and related specialty and group-practice considerations. The piece also points readers to the corresponding CPT guidance and a related flow chart in the E/M Services Guidelines.
Why This Topic Matters
Correctly classifying new versus established patients is a core prerequisite for selecting the appropriate office/outpatient E/M code set. Misclassification can affect coding accuracy and compliance, so this topic is important for anyone involved in professional service reporting.
Article Sections
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Introduction
Introduces the purpose of the tool and the general problem of distinguishing between new and established patients.
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Five-question decision path
Presents a sequence of questions used to evaluate patient status across prior services, physician relationships, specialty, subspecialty, and practice identifiers.
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Reference to CPT guidance
Notes a related flow chart in the CPT E/M Services Guidelines and identifies the source publication.
What You Will Learn
- How the article frames the distinction between new and established patients
- What broad factors are considered in the decision path
- Where related CPT guidance can be found
- How the topic relates to office and outpatient evaluation and management services
Who Should Read This
- Medical coders
- Billing staff
- Physicians and other professional providers
- Compliance and documentation teams
Codes Discussed
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