Must a problem be new to the patient or new to the provider in order for it to be considered a "new problem" when scoring diagnosis/management options for an evaluation and management (E/M) service?

Answer:
In most instances, a new problem is one that is new to the provider and being addressed at 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.

Resources:

 

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 


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