tci E/M Coding Alert - 2015 Issue 7

You Be the Coder: Specialty Designation Matters in New vs. Established

Question:If a patient is referred to our practice for otitis media in 2014 from Dr. Smith and then is referred back to us in 2015 for tonsillitis by Dr. Jones. Is the patient new or established for the 2015 visit? Georgia Subscriber  Answer: The patient is established, and you should report an E/M code in the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) range for the 2015 encounter.  Here’s why: The chief factor in determining whether a patient is new or established is time. You must decide whether...

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