Have you ever noticed the “Decision Tree for New vs Established Patients” in your Current Procedural Terminology (CPT®) manual? The decision tree is located under the Evaluation and Management (E/M) Services Guidelines section of the CPT manual. The E/M decision tree was developed in 1999, first printed in CPT 2007, and revised in CPT 2008. The purpose of the decision tree is to assist physicians and coders in determining whether an E/M service should be assigned a new or an established patient code. The decision tree is only applicable to those E/M service codes that distinguish between new and established patient services (ie, office/outpatient codes 99201–99215; home, domiciliary, rest home, or custodial care codes 99324–99337; and preventive medicine service codes 99381–99397).

The following questions are considered when using the decision tree:

Remember that the CPT “Decision Tree for New vs Established Patients” may not be consistent with individual...

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