Part B Insider - 2007 Issue 2
CPT 2007: Go With the Flow to Determine 'New' vs. 'Established'
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Article Overview
This article reviews CPT 2007 guidance on determining whether a patient should be considered new or established for E/M coding. It focuses on the general factors that affect that determination, including prior encounters, shared group billing arrangements, specialty differences, and whether services were face-to-face. The article is useful for coders, billers, and clinical practice staff who assign outpatient and office-based evaluation and management services.
Why This Topic Matters
Patient status affects which E/M code family is selected, so accurate interpretation of the guidance helps support consistent coding for office and similar encounters.
Article Sections
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3-Year Rule Still Applies
Explains the time-based framework used to distinguish patient status under CPT 2007 and describes the general context in which it is applied.
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Location Doesn't Factor In
Discusses how shared group billing and specialty relationships can affect patient status even when care occurs at different sites.
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Face-to-Face Matters
Reviews the role of direct patient contact in applying the patient-status framework to E/M services.
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Different Specialties Can Make the Difference
Covers how physician specialty distinctions within a practice can affect whether a patient is treated as new for coding purposes.
What You Will Learn
- How CPT 2007 frames the distinction between new and established patients
- What general service and practice factors influence patient-status determination
- How specialty relationships and encounter type affect E/M coding context
- Which broad outpatient and office-based services are addressed by the guidance
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physicians and other clinicians involved in E/M documentation
Codes Discussed
Code Ranges Discussed
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