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2 definitions are key to new initial, subsequent visit guidelines

By Part B News  
   December 09, 2022

Study the new CPT guidelines for initial and subsequent services before you code an inpatient, observation or nursing facility visit in 2023.

The guidelines are based on the long-standing policy for new and established patients, explained Peter Hollman, M.D., co-chair of the AMA E/M workgroup, on Nov. 16, the first day of the 2023 CPT and RBRVS Symposium.

However, the relevant time period is the length of the stay, not three years. “When you look at initial or a subsequent patient encounter in the inpatient setting, just look at it from the time they were admitted to the current time,” Hollman said during the event.

According to the new guidelines, “an initial service is when the patient has not received any professional services from the physician or other qualified health care professional [QHP] or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the inpatient, observation, or nursing facility admission and stay.”

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