How to identify a New Patient when billing an Evaluation and Management (E/M) code?

Classification of Evaluation and Management (E/M) Services
When reviewing E&M services they are split up into broad categories like office visits, hospital visits and consultations. Most of the categories are further divided into two or more subcategories of Evaluation and Management services.

First identify if the patient is a new patient by asking yourself the following questions:
1. Has your provider ever treated this patient before?
2. Has any of the other providers within the same specialty who belongs to the same group practice ever treated this patient within the last 3 years?
If you answered No to both of these your patient is a New patient.

An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years

If the doctor has another provider “on call” for him, the patient’s encounter will be classified as if the patient had been treated by his normal doctor.

Emergency departments do not look at patients as New or Established.

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