What determines whether a patient is billed with new or established patient E&M codes?

What determines whether a patient is billed with new or established patient E&M codes?

• A. The time since the last hospitalization
• B. The patient's blood type
• C. Whether the patient has been seen in the office within the last three years
• D. The physician's specialty

Answer: (C)

New versus established status is determined by whether the patient has received professional services from the same physician or group within the last three years. If the patient has not been seen in that practice in the past three years, they’re billed as a new patient; if they have been seen within that window, they’re billed as established. This distinction tracks familiarity and documentation expectations for the encounter. Time since hospitalization, blood type, or the physician’s specialty do not set this status.

New versus established status is determined by whether the patient has received professional services from the same physician or group within the last three years. If the patient has not been seen in that practice in the past three years, they’re billed as a new patient; if they have been seen within that window, they’re billed as established. This distinction tracks familiarity and documentation expectations for the encounter. Time since hospitalization, blood type, or the physician’s specialty do not set this status.