Understanding New Patient in Medical Coding

There are countless diseases and ailments that are faced by humans daily which are diagnosed and treated by physicians all around the world. To facilitate understanding these ailments and study how people can be provided good quality healthcare, the different ailments and treatments are given certain codes that are internationally acceptable. This process of transforming healthcare diagnoses, procedures, and medical services into universally acceptable alpha-numeric codes is called medical coding. The professionals who do this work are medical coders and the information for medical coding is collected from the medical transcription reports and other healthcare documents.

An important aspect of coding is, deciding if a patient is new or established. It is significant to distinguish between an established and a new patient to assign appropriate evaluation and management (E/M) codes, comply with the coding guidelines, and get accurate reimbursements for the services provided. For this purpose, it is important to understand who is a new patient. So, how do people in medical coding jobs know if a patient is new or established? Current Procedural Terminology (CPT) is a popular medical code set that is widely accepted and according to its guidelines the new and established patients are defined. Even before deciding on if a patient is new or not, it important for coders in the medical coding companies to understand what is a professional service. In the context of evaluation and management codes, professional services are those face-to-face services provided by physicians or any qualified healthcare professionals who report E/M services reported by CPT codes.

Per the CPT guidelines, a patient who has not received any professional services from a physician or a qualified healthcare professional of the exact same specialty and sub-specialty belonging to the same group practice within the last three years is called a new patient. Also, an interpretation of a lab test etc. in the absence of an E/M service or a face-to-face service will not affect the designation of a new patient. Here it is to be understood that if a patient becomes an established patient with a healthcare professional in a group practice, the patient becomes an established patient with all the physicians and healthcare professionals in that specialty or sub-specialty of the group. However, if a physician is new to the group practice, and sees an established patient of the group, then the patient may be considered a new patient for the purposes of physician billing.

Only with proper training and experience can the people in medical coding jobs identify a new patient properly. This is because in some cases, a patient may be classified as new by two providers of the same group if they are seeing the patient for different reasons and the providers belong to different specialties. For the best on-the-job training and experience join Avontix, one of the best medical coding companies in Hyderabad