• E/M codes are used by all physician specialties and all other duly licensed
health providers.
• The definitions of new patient and established patient are important because
of the extensive use of these terms throughout the guidelines in the E/M section.
A new patient is defined as one who has not received any professional
services from the physician or another physician of the same specialty who
belongs to the same group within the past 3 years. An established patient
is one who has received professional services from the physician or another
physician of the same specialty who belongs to the same group within the past
3 years. When a physician is on call covering for another physician, the decision
as to whether the patient is new or established is determined by the relationship
of the covering physician to the physician group that has provided care
to the patient for whom the coverage is now being provided. If the doctor is
in the same practice, even though she has never seen the patient before, the
patient is considered established. There is no distinction made between new
and established patients in the emergency department
The other terms used in the E/M descriptors are equally as important.
The terms that follow are vital to correct E/M coding
• Problem-focused history
• Detailed history
• Expanded problem-focused history
• Comprehensive history
• Problem-focused examination
• Detailed examination
• Expanded problem-focused examination
• Comprehensive examination
• Straightforward medical decision making
• Low-complexity medical decision making
• Moderate-complexity medical decision making
• High-complexity medical decision making
• E/M codes have three to five levels of service based on increasing amounts of
work.
