If a cardiologist reviews, interprets, and bills for the interpretation of an electrocardiogram (ECG) or a neurologist reviews, interprets, and bills for the interpretation of an electromyogram (EMG) for a patient who has never been seen before by the practice as part of a routine round of interpretations for a hospital, and then sees that patient in the office, is that patient considered a new patient or an established patient to the practice? ...
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Article Overview
This article addresses a common CPT evaluation and management question for cardiology and neurology practices: whether interpreting a hospital diagnostic test before an office visit changes a patient’s status for billing purposes. It summarizes the relevant CPT 2022 E/M services guidance, the concept of professional services, and the new vs. established patient framework, and points readers to the CPT Professional codebook for further reference.
Why This Topic Matters
Correctly determining patient status affects office visit reporting and can prevent E/M billing errors when a physician or QHP has only interpreted a test in the hospital before seeing the patient in person.
What You Will Learn
- How CPT E/M guidance defines a new patient versus an established patient.
- How prior diagnostic test interpretation is treated in the context of patient status.
- Where to find the CPT guidance that supports the new vs. established patient determination.
- How the article frames this issue for hospital-based test interpretation and later office visits.
Who Should Read This
- Cardiologists
- Neurologists
- Physicians
- Qualified health care professionals
- Medical coders
- Billing staff
- E/M coding auditors
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