New and Established Patients
Description
In this course, participants will delve into the critical distinction between new and established patients in the realm of Evaluation and Management (E/M) services. This comprehensive program offers a deep understanding of the definitions provided by the Current Procedural Terminology (CPT) guidelines for new and established patients. From deciphering what constitutes a new or established patient to exploring the impact on professional services, place of service, and unusual situations, this course equips coders with the knowledge and expertise necessary for precise E/M code selection.
Included Lessons:
- What Is A New Patient For Evaluation and Management (E/M) Services?
- What Is An Established Patient For E/M Services
- What Is A Professional Service
- Patient Status Based On Services Provided And Place Of Service (POS)
- Unusual Situations
- Organizational Impact
CEUs available for the following credentials:
AAPC
COC, CPC, CPC-P, CANPC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMA, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC
AHIMA
CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS
Key Takeaways
This course will empower medical coders with the knowledge and skills needed to confidently and accurately navigate the complexities of patient status determination in E/M coding, contributing to efficient and compliant medical coding practices. Some key takeaways include:
- Clear Understanding of New vs. Established Patients: Coders will have a comprehensive grasp of the definitions and criteria that differentiate new patients from established ones in accordance with CPT guidelines.
- Proficiency in E/M Code Selection: Coders will be adept at selecting the appropriate E/M codes based on patient status, services provided, and place of service, ensuring accurate billing and reimbursement.
- Knowledge of Professional Services: Coders will have a solid understanding of what constitutes professional services and how they relate to E/M coding, enabling them to code these services correctly.
- Unusual Situations Handling: Coders will be equipped to navigate unusual situations, such as changes in provider practice or multispecialty group practices, and understand the impact on patient status designation.
- Preventive Services Differentiation: Coders will be able to distinguish between preventive medicine services for new patients and those for established patients, preventing billing errors.
- Organizational Impact Awareness: Coders will recognize the importance of accurate E/M code reporting and how it impacts reimbursement and organizational financial health.
- Compliance with Medicare Guidelines: Coders will be aware of which E/M codes are recognized by Medicare and ensure coding practices align with Medicare guidelines.
- Provider NPI and Location Changes: Coders will understand how provider NPIs and changes in practice locations (Tax ID) affect patient status designation.
Benefits of Taking this Course
- In-Depth CPT Understanding
- Precise E&M Code Selection
- Mastery of Patient Status Criteria
- Increased Coding Confidence
- Enhanced Career Advancement
FAQs
What is the significance of distinguishing between new and established patients in medical coding?
How do I determine if a patient is considered "new" or "established" based on CPT guidelines?
According to CPT guidelines, a new patient is one who has not received any professional services from the physician or a physician of the exact same specialty and subspecialty in the same group practice within the past three years. An established patient, on the other hand, has received professional services from the same specialty and subspecialty physician within the past three years.
What happens if a physician joins a new practice, and the patient was previously seen by them in their old practice?
About our Medical Coding Courses
Overview
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