Part B Insider - 2004 Issue 4
You Be The Coder: Can 'New' and 'Established' Affect Consults?
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Article Overview
This article addresses a common office coding question about consult billing when a patient has been seen before and is now seen by a different physician in the same practice. It is aimed at coders and billing staff working with physician office evaluation and management services, and it discusses the broad distinction between outpatient visit categories and consult services, along with the documentation elements tied to consult reporting.
Why This Topic Matters
Correctly distinguishing consults from standard office E/M services affects claim selection, compliance, and whether a visit can be reported under consult rules versus an established patient visit category.
What You Will Learn
- How the article frames consults in relation to new and established patient status
- What broad documentation elements are associated with reporting an office consult
- How physician practice structure is relevant to patient status in this scenario
- When an established patient E/M category is discussed as an alternative
Who Should Read This
- Medical coders
- Billing specialists
- Physician office staff
- Compliance teams
Codes Discussed
Code Ranges Discussed
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