CMS Allows ’97 Extended HPI with ’95 Guidelines

Effective Sept. 10, the Centers for Medicare & Medicaid Services (CMS) has revised its Evaluation and Management (E/M) Documentation Guidelines (DG), to allow physicians to use the 1997 DG for an extended history of present illness (HPI) with the other elements of the 1995 DG to document an E/M service. As a result, “the status of three or more chronic conditions” qualifies as an Extended HPI for either set of DGs.

The revised guideline is presented as a Question and Answer on the CMS website:

Evaluation and Management – CEMC

FAQ on 1995 & 1997 Documentation Guidelines for Evaluation & Management Services.

Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code?

A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013 physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service.

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7 Responses to “CMS Allows ’97 Extended HPI with ’95 Guidelines”

  1. Janis Bishop says:

    I have to say I agree with this although it will be a bit of a learning curve. There have been times I have not been able to get to the extended HPI that I felt the provider deserved. And, the auditing software programs will have to catch up…..

  2. Lisa says:

    Does this apply to Chiropractic care as well?

  3. Deb Hughes says:

    The CMS states 97 DG may be used for Extended HPI in combination with 95 DG. What about 97 DG with 3 or more chronic conditions for a Comprehensive HPI? Can we combine the 95 DG in that situation? I found it interesting that is only referenced Extended HPI.

  4. Deb Hughes says:

    Duh, what a silly question I asked. Please disegard. I reread notice and understand clearly, now!

  5. Crystal Schultz says:

    Has anyone seen any other information/notifications from other sources on this change? I would feel more comfortable implementing this if CMS put some sort of official notice out.

  6. Lee Williams says:

    CMS has an FAQ on this if you google the 95 or 97 CMS DG, you’ll have access to it. Use this as your resource.

  7. Jo says:

    If a physician documents “no modifying factors” in the HPI portion of their note can they get credit for the Modifying Factors Element?

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