Wiki 95 or 97 guidelines

[TAMMYS]

When auditing one physician with multiple patients is it ok to switch between the 95 and 97 guidelines to benefit the physician.

I know you can not combine the guidelines per patient visit, but can you use 95 guidelines for one visit and on the next visit (same patient/same physician) use 97?

Thank you

 

[RebeccaWoodward*]

Yes...as long, as you have already stated, you don't combine the DG within the patient encounter and if you're practice doesn't have a policy to use a certain set.

"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)."

https://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp

 

[nuenz@yahoo.com]

you need to check your compliance plan to ensure that it isn't specific to which set of guidelines your practice will use.
Danielle Carroll, CPC