Wiki 1995 or 1997 Guidelines/choose 1 and stick to it?

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punkyboo

punkyboo

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Hi all,

I have looked and looked and can't seem to find anything concrete on my question.

I could swear I was told before that an office had to choose which guidelines to use in E/M documentation (1995 or 1997) and stick with that. Now I have been told that the office can choose to use 1995 or 1997 guidelines, on a case by case basis.

I need to know because apparently the Medicare RAC is "knocking at our door." Yikes...

~Kat
 
katcpc said:
Hi all,

I have looked and looked and can't seem to find anything concrete on my question.

I could swear I was told before that an office had to choose which guidelines to use in E/M documentation (1995 or 1997) and stick with that. Now I have been told that the office can choose to use 1995 or 1997 guidelines, on a case by case basis.

I need to know because apparently the Medicare RAC is "knocking at our door." Yikes...

~Kat
Click to expand...

Carriers and A/B Medicare Administration Contractors (MACs) are to continue reviews using both the 1995 and 1997 Documentation Guidelines for E&M Services (whichever is more advantageous to the physician).

http://www.cms.hhs.gov/MLNEdwebGuide/25_EMDOC.asp

You have the option of both; however, you must use one set of guidelines for that patient encounter.
 
I took an E&M seminar a couple of months ago and she claimed that either/or is fine, although, it seems that the clinics choose to stick with the 1997 DG's, since it is more advantagous to them. Then she said that most auditors from CMS like to use the 95 DG's, which are a little more refined than the 97 DG's, which is what I use in the hospital that I work at. Whether or not that is the golden rule, I can't be sure, but it certainly made sense to me.
 
If you don't have one already, I would definitely have a policy and procedure in place to protect your organization. That is one of the first things CMS asks for when there is an audit.
 
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