Reader Question: Use 99201-99205 if Patient Switches to Your Office

Why This Topic Matters

Correctly distinguishing new and established patient office visits affects compliant E/M reporting and helps avoid errors when a patient relationship changes from temporary coverage to ongoing care. The article also highlights that Medicare reciprocal billing rules may differ from private payer guidance, making payer context important.

Article Sections

1. Question

   Introduces the billing scenario involving a patient who was previously seen during coverage and later comes to the practice to establish care.

2. Answer

   Provides the article’s guidance on how the encounter is categorized for office visit reporting and frames the issue in terms of physician coverage and patient relationship status.

3. Medicare and reciprocal billing context

   Explains how coverage arrangements and reciprocal billing concepts relate to E/M reporting under Medicare-oriented rules.

4. Establishing the patient relationship

   Addresses the scenario in which the patient is now presenting to begin ongoing care and the practice lacks prior records indicating professional services.

5. Note

   States that payer policies may vary and that private insurers can publish their own reporting guidance.