tci E/M Coding Alert - 2013 Issue 1

Back to Basics: Pay Attention to 3-Year Rule to Decide Between New vs. Established Codes

The location of the encounter won’t be the deciding factor. Even before you start looking at the history, exam, and medical decision making components of an office visit, you first need to determine if the patient is new or established. Whether you report 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) or 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient …) depends on the answer. Understanding the essential three-year rule will make that choice a breeze. Take a look at what...

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