New & Established Patients

Question 1

Codes for Office and Outpatient Services are often divided by whether the patient is ____ or_____

Answer 1

New or Established

Question 2

According to CPT Guidelines a NEW PATIENT:

Answer 2

NEW PATIENT

HAS NOT RECEIVED any Professional Services from a Physician or Qualified Healthcare Professional in the Same Group with the Exact Same Specialty and Subspeciality within the Last 3 YEARS.

Question 3

According to CPT Guidelines an ESTABLISHED PATIENT:

Answer 3

ESTABLISHED PATIENT

HAS Received Professional Services from the Physician or Qualified Healthcare Professional, or One in the Same Group Practice with the Exact Same Specialty or Subspeciality within the the LAST 3 YEARS.

*This INCLUDES: Advanced Practice Nurses or Physician Assistants WORKING WITH the Physician or Healthcare Professional.

Question 4

PATIENT HISTORY is divided into:

Answer 4

PATIENT HISTORY

3 Parts:
1. History of Present Illness (HPI)
2. Review of Symptoms (ROS)
3. Past, Family, Social HIstory (PFSH)

*When selecting an E/M code, be sure that the physician or other qualified healthcare professional is collecting a medically appropriate history from the patient based on their complaint.

Question 5

PATIENT HISTORY

1. History of Present Illness (HPI)

Answer 5

PATIENT HISTORY

Otherwise known as HPI

EVALUATION OF THE PATIENT’S COMPLAINT

When Applicable Include:
Location
Quality of Discomfort
Severity (often rated on scale 1-10)
Associated Symptoms
How Often the Complaint Occurs
When it Began
Anything that Makes It Better or Worse

Question 6

PATIENT HISTORY

2. Review of Symptoms (ROS)

Answer 6

PATIENT HISTORY

Otherwise known as ROS

ALLOWS THE PHYSICIAN TO SELECT WHAT OTHER BODY SYSTEMS ARE AFFECTED

Question 7

PATIENT HISTORY

3. Past, Family, & Social History

Answer 7

PATIENT HISTORY

Otherwise known as PFSH

EVALUATES A PATIENT’S PAST MEDICAL CONDITIONS, FAMILY HEALTH CONDITIONS, AND TOBACCO AND ALCOHOL USE.

Question 8

EXAMINATION

Answer 8

EXAMINATION

THE PHYSICAL OR CLINICAL INSPECTION OF A PATIENT’S AFFECTED AREAS OR BODILY SYSTEMS.

*When selecting an E/M code verify that the physician or other qualified healthcare professional is collecting a medically appropriate examination from the patient based on the complaint.

Question 9

Body Areas and Organ Systems are organized as followed:

Answer 9

1. head (and face)
2. neck
3. chest (breast and axilla)
4. abdomen
5. genitalia (with the groin and buttocks)
6. back
7. arms
8. legs
9. hands
10. feet
11. eyes
12. ears
13. nose
14. throat
15. mouth
16. cardiovascular system
17. respiratory system
18. gastrointestinal system
19. genitourinary system
20. musculoskeletal system
21. skin
22. neurological system
23. psychiatric
24. hematological (lymphatic & immunological)