tci E/M Coding Alert - 2019 Issue Q3

Reader Question: Determine New vs. Established by Service, Not E/M

Question: A patient came in for an E/M service on February 19, 2019. The patient previously received an E/M service from our practice on September 29, 2014. However, the patient also came in for allergy immunotherapy during the interim, and we documented 95165 several times, the most recent being June 13, 2018. Is the patient regarded as new or established to our practice? New York Subscriber Answer: Both the CPT® and Centers for Medicare and Medicaid Services (CMS) definitions for established patients are the same: they are patients “who received professional services from the physician/NPP or another...

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