Part B Insider - 2023 Issue 2
You Be the Coder: Clarify ‘Established Patient’
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Article Overview
This premium coding article addresses how to classify a patient as new or established when a physician joins a practice and continues care for a prior patient. It is aimed at coders, billers, and practice staff who need to apply CPT-based patient status guidance within office and other outpatient E/M reporting. The article discusses the general timing rule, the role of prior professional services, and the importance of a face-to-face encounter when evaluating patient status.
Why This Topic Matters
Patient status affects evaluation and management code selection and can impact claims accuracy, compliance, and workflow for practices that have physicians joining from other groups.
What You Will Learn
- How patient status is evaluated in a group practice context
- Why the timing of prior professional services matters
- How face-to-face services factor into patient classification
- How CPT guidance relates to established patient reporting
- Which broad E/M coding context is relevant to follow-up visits
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office staff
- General surgery practices
Codes Discussed
Code Ranges Discussed
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