Michael last visited his physician, which is a single-physician office practice, in September 2006. He is at the office today for a sore throat and chest congestion. Since he was already a patient, the medical insurance coder submitted an established patient E/M code to Michael's insurance carrier for payment. The insurance carrier requested additional documentation regarding the visit. Which of the following may have been the reason?

Question

Quizplus · Accepted Answer

Michael's visit should have been coded as a new patient E/M (Evaluation and Management) category because he had not been seen in the practice for over three years. According to most insurance carriers, a patient is considered new if they have not received any professional services from the physician or another physician of the same specialty and in the same practice within the past three years.

Michael Last Visited His Physician, Which Is a Single-Physician Office