Ob-Gyn Coding Alert

Reader Question:

Decide Between '95 and '97 Guidelines Case-by-Case

Question: Is it true that we can use either the 1995 or the 1997 documen­tation guidelines for evaluation and management services? If so, how do I know which one to use?

Virginia Subscriber

Answer: Yes. For many payers, including Medicare, you may choose to report E/M services based on either the 1995 or 1997 documentation guidelines. You can switch between the different versions from one encounter to another. When choosing between the two sets of guidelines, consider the content of your provider’s documents, the specific details captured in the record, the medical necessity of the information, and the specialty for which you code. File based on the 1997 documentation guidelines for HPIs that include the status of three chronic conditions along with the exam criteria from the 1995 guidelines, or vice versa, using the 1995 HPI criteria with the 1997 exam guidelines.

It’s different now: In the past, you had to pick either the 1995 or 1997 guidelines and use your choice for the entire encounter. However, CMS changed its policy, so now for services performed on or after September 10, 2013, physicians may use the 1997 documentation guidelines for an extended HPI, along with other elements from the 1995 guidelines to document the E/M service. 

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