New and Established Patient E/M Definitions (CMS vs. CPT ®)

I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient. Identifying the correct classification will prevent delays or denials of payment.  Many evaluation and management (E/M) codes are by definition described as new or established.  This lecture will attempt to explain various important clinical aspects related to this determination. Keep in mind while the Centers For Medicare& Medicaid Services (CMS) uses Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT ® definitions. This discrepancy often leads to confusion for practitioners. I will attempt to provide some insight into these differences as well. I am a practicing clinical hospitalist with over ten years of experience and I understand how complicated these E/M rules can be. I have written an extensive collection ofCPT ® and E/M lectures to help physicians and other non-physician practitioners (NPP) navigate the complex rules of medical billing and coding.  The Medicare Evaluation and Management Services Guide onpage six previously  defined a qualified NPP as nurse practitioners, clinical nurse specialists, certified nurse midwives and physician assistant. I could not find this definition in the most updated version.CPT ® DEFINITION OF NEW VS. ESTABLISHED PATIENTSThe CPT ® definition of a new patient underwent subtle changes in 2012. U...

Source: The Happy Hospitalist - February 27, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs