Part B Insider - 2005 Issue 9
READER QUESTIONS: '3-Year Rule' Applies to Practice,Not Physician
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Article Overview
This reader Q&A addresses a common office coding scenario involving patient status within a group practice. It focuses on how the three-year rule applies to the practice rather than the individual physician, and it explains the general implications for evaluation and management visit coding in that setting. The article is aimed at medical coders, billers, and practice staff who need to understand whether a patient is treated as new or established for coding purposes.
Why This Topic Matters
Correctly identifying patient status affects office and outpatient E/M coding and helps avoid billing errors when patients see a different clinician within the same group practice. The article is relevant to organizations that bill under shared provider numbers and need consistent coding policies.
What You Will Learn
- How the three-year rule relates to patient status in a group practice
- How changes in treating physicians within the same practice affect new versus established patient classification
- Why office and outpatient E/M coding depends on whether the patient is considered new to the practice or established
- What general considerations apply when a patient returns with a new problem after a long gap in care
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice administrators
- Physician office staff
Codes Discussed
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