tci Part B Insider - 2013 Issue 39

Part B Coding Coach: Navigate the New-Versus-Established-Patient Maze With Expert Tips

Different locations, same physician? Use established patient codes. When reporting many common E/M services, you must ask yourself two questions: First, is the patient new or established? And second, what are the documented levels of history, physical exam, and medical decision-making (MDM)? We’ve got some quick tips on how to use this information to select the correct E/M level every time. 3 Year Rule Determines Patient Status Generally, you should consider a patient to be established if any physician in your group (or, more precisely, any physician of the same specialty billing under the same group number) has...

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