Medicare Compliance & Reimbursement

Financial fallout can be considerable if you eschew new patient codes too often. For medical practices, the biggest difference between a new and established patient evaluation and management service is simple: money. Service-wise, new and established patient visits often differ little: the new patient E/M often includes simple tasks such as, "setting up a new chart and quizzing the patient a little closer to get familiar with him," explains Quinten A. Buechner, M.S., M.Div., AAPC:CPC, BMSC:ACS-FP/GI/PEDS, ACMCS:PCS, PHIA:CCP, PAHCS:CMSCS, president of ProActive Consultants, LLC in Cumberland, Wis. Bottom line: When you report a new patient E/M, it pays out at a higher rate, Beuchner says. Keep in mind, however, that the level of service requirements are more stringent with new patients who are required to meet or exceed the chosen level in all three E/M components; established patients must meet or exceed E/M level in two out of three components. [...]