E/M Weekly Tip: Diagnosis and Management Options - New Problem

In most instances, a new problem is one that is new to the provider and being addressed during that visit. There are two exceptions to this general rule:

  • The initial visit of an established beneficiary in a single specialty group practice setting with a new provider
  • A visit by an "on call" or covering provider. In these instances, the established problems are treated as if the beneficiary was seen by the unavailable provider.

Resource: CMS 1995 & 1997 E/M Guidelines.