Correctly Coding E/M in Medical Billing

New medical billing coding interpretation may add more reimbursement to your reimbursements. The Centers for Medicare & Medicaid Services clarified the rules for a new patient evaluation and management codes. In reality, there has been no real medical billing policy change to the language the policy is written in; it is simply going to be interpreted differently by the Centers for Medicare & Medicaid Services. Now, the definition of “new patient” means someone none of the physicians in the practice have seen in the last 36 months face-to-face.

Some medical billing staff members may get confused when it comes to lab work and other non-face-to-face procedures. If a patient is seen for lab work at your office, and then comes in for the first face-to-face visit the next week, your medical billing personnel can bill this as a new patient visit. You can also do medical billing for a new patient if it has been 37 months since the last visit.

This medical billing definition clarification may end up putting more money in many doctor’s reimbursements as a new patient consult is generally reimbursed at a higher rate than an established patient visit.

Make sure your staff knows to look to see when the last face to face meeting with your patient was when putting together their medical billing to see if you can take advantage of this new interpretation. Better yet, outsource your medical billing claims to the pros who keep up with the changes in the medical billing and coding industry and all you have to worry about is servicing your patients, not when the last time your saw your patient was.

View all Articles by: Melissa Clark, CCS-P