95-97 Coding Guidelines for E&M levels

chenson384

Contributor
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Paducah Kentucky
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I (and lots of people I work with or have worked with in the past)have been under the impression that a coder had the choice of using the 95 or 97 guidelines when coding office visits within a single clinic. I have searched in my CPT book for guidance, it seems to follow the 97 set-(constitutional symptons on inclusive to the ROS)

In a recent encounter with another coder, she stated the clinic had to decide on one set of guidelines and not use either/or. She is presently working for a clinic that goes by 95 guidelines only and has a part-time at home job for a clinic that goes by the 97 guidelines only.

Does a decision have to be made for one set or the other?
 

rthames052006

True Blue
Local Chapter Officer
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York, Pa
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I (and lots of people I work with or have worked with in the past)have been under the impression that a coder had the choice of using the 95 or 97 guidelines when coding office visits within a single clinic. I have searched in my CPT book for guidance, it seems to follow the 97 set-(constitutional symptons on inclusive to the ROS)

In a recent encounter with another coder, she stated the clinic had to decide on one set of guidelines and not use either/or. She is presently working for a clinic that goes by 95 guidelines only and has a part-time at home job for a clinic that goes by the 97 guidelines only.

Does a decision have to be made for one set or the other?
I've heard of some offices/clinics who do have a guideline they follow for what DG they use at their facility/office.

It would be up to the office/facility but you would want to check with your carrier if they use a specific one. I know my local Medicare Carrier uses the one that will benefit the provider.
 
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