In a multiple provider same specialty practice, a New patient has a new problem. One month later, if the patient sees another provider same specialty, same tax ID, is this: A) an Established problem or B) a new problem because this is a new provider? ...
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Article Overview
This short coding guidance article addresses how patient status is determined in a multiple-provider, same-specialty practice when a patient returns to the group after a recent visit. It is intended for coders, billers, and clinical office staff who work with CPT evaluation and management rules and need to understand the general patient-status framework used in office visit coding. The article points readers to CPT evaluation and management guidance and a decision tree in the CPT Professional Edition.
Why This Topic Matters
Correctly identifying whether a visit is treated as new or established affects evaluation and management coding in group practices. This topic is especially relevant where more than one provider shares the same specialty and tax ID.
What You Will Learn
- How CPT patient status is considered in a same-specialty group setting
- How multiple providers in the same practice affect the new versus established question
- Where CPT evaluation and management guidance addresses patient-status decisions
- How a decision-tree approach is used in the referenced CPT materials
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Clinical office staff
- Revenue cycle staff
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