ICD-10-CPT Coding Practice Exam

The definition of a new patient is critical in the context of medical billing and coding, particularly for the determination of appropriate evaluation and management (E/M) services. The correct answer indicates that a new patient is defined as someone who has not received professional services from the physician, or from another physician of the same specialty within the same group practice, in the past three years.

This three-year timeframe is established to ensure that a fresh assessment of the patient's condition can be conducted during the visit. It acknowledges significant changes that may occur in a patient’s medical history or condition over time, leading to a more accurate and comprehensive evaluation. Recognizing this timeframe helps in appropriately coding for services, ensuring that providers are reimbursed correctly according to the patient's established status.

Other timeframes provided in the other choices are not aligned with the established guidelines for defining a new patient status, emphasizing the importance of using the proper parameters to avoid billing errors or misrepresentations of patient encounters.