In Coding
Feb 12th, 2018
When selecting among E/M codes with “new” and “established” patient categories, most coders know to follow the so-called three year rule. If the provider has seen the patient in the past 36 months, the patient is established. It’s important to stress that the provider must have seen the patient. The Centers for Medicare & Medicaid ...
In CMS
Feb 15th, 2016
Most professional coders—even relative beginners—are familiar with the “three-year rule” to determine whether a patient is “new” or “established” with a provider. One common conundrum is how to determine the patient’s status (new or established) if a provider has seen a patient previously, in another location. CPT Assistant (June 1999) explains: Consider Dr A, who ...
In Billing
May 1st, 2014
Understand new and established patient requirements and how to apply them. By G.J. Verhovshek, MA, CPC Most professional coders—even relative beginners—are familiar with the “three-year rule” to determine whether a patient is new or established with a provider. But that familiar rule has a few wrinkles that make determining patient status more complex than you might ...
Jan 1st, 2012
Successfully apply E/M code modifications in several service categories. With the release of CPT® 2012, evaluation and management (E/M) guidelines have been updated to clarify the meaning of “new” vs. “established” patients, and code use has been modified for several service categories. Here’s what you need to know to apply these changes successfully. Three-year Rule ...
Dec 1st, 2011
Whether it’s new modifiers, E/M, radiology, or Category II codes, we have the outlook for what’s on the horizon. By Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC CPT® 2012 arrives with over 500 code changes, plus minor additions to the Evaluation and Management Services Guidelines. The revised evaluation and management (E/M) guidelines clarify the “three-year ...