Avoid Billing Risks for New vs. Established Patients

With the updates to CPT definitions and payer guidelines, the reason for learning to distinguish new patients from established patients, apart from following coding guidelines, is that it enables practices to be more efficient and effective with appropriate reimbursement for patient visits, while also minimizing audits and other payer scrutiny.

See the decision tree graphic above for determining if a patient is new or established. For additional questions or information on coding and billing training, contact the ACR coding and practice management department at [email protected].

References

Current Procedural Terminology (CPT) 2018. American Medical Association.
Medicare Claims Processing Manual (Chapter 12)—Physicians/Nonphysician Practitioners (30.6.7).

A guide to ensure proper coding, billing and accurately diagnose patients.

The ICD-10 page on the Centers for Medicare & Medicaid Services (CMS) website features a countdown clock that shows the time left until Oct. 1, 2015, the date on which compliance with the new code set becomes mandatory. By the time this issue goes to press, the clock will read 90 or fewer days. Time…

It is essential for coders to understand the rules of engagement, especially when it comes to correct coding and using the most up-to-date coding tools. Those who interact with Current Procedural Terminology (CPT), the International Classification of Diseases (ICD), or insurance companies also have the experience of dealing with the countless coding rules and guidelines.

After 25 years, the American Medical Association (AMA) Current Procedural Terminology (CPT) office and outpatient evaluation and management (E/M) codes received a major overhaul. These changes, which went into effect Jan. 1, will help reduce administrative burden on providers and roll back some of the rigid requirements for E/M coding by simplifying the code selection…

References

Steps to Help Rheumatologists Achieve Office Compliance in Laboratory Coding

Prepare NOW for ICD-10 Medical Coding Transition

The Anatomy of Coding

A New Era of Coding Evaluation & Management Services

References

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