How is a “new patient” defined in the context of E/M coding?

How is a “new patient” defined in the context of E/M coding?

• A. A patient who has not been seen in the past year
• B. A patient who has not received services from a physician in the past three years
• C. A patient who switches insurance providers
• D. A patient who requires initial consultation

Answer: (B)

In the context of Evaluation and Management (E/M) coding, a “new patient” is specifically defined as a patient who has not received professional services from a physician or qualified healthcare professional, or from another physician of the same specialty in the same group practice, within the past three years. This definition helps to clarify the criteria for establishing whether a patient’s visit can be billed as a new patient encounter rather than an established patient encounter, which has different coding implications. Classifying a patient as "new" affects the level of service and the corresponding reimbursement that the healthcare provider can receive. When a physician treats a new patient, it often requires a more comprehensive history and examination, thereby justifying a higher level of service coding. This definition is established by CMS (Centers for Medicare & Medicaid Services) guidelines, emphasizing the need for clear distinctions between new and established patients in coding practices to ensure appropriate billing and reimbursement.

In the context of Evaluation and Management (E/M) coding, a “new patient” is specifically defined as a patient who has not received professional services from a physician or qualified healthcare professional, or from another physician of the same specialty in the same group practice, within the past three years. This definition helps to clarify the criteria for establishing whether a patient’s visit can be billed as a new patient encounter rather than an established patient encounter, which has different coding implications.

Classifying a patient as "new" affects the level of service and the corresponding reimbursement that the healthcare provider can receive. When a physician treats a new patient, it often requires a more comprehensive history and examination, thereby justifying a higher level of service coding.

This definition is established by CMS (Centers for Medicare & Medicaid Services) guidelines, emphasizing the need for clear distinctions between new and established patients in coding practices to ensure appropriate billing and reimbursement.