I am hoping someone can shed some light on this. I have always followed the 97 guidelines, never really paid much attention to CPT E/M guidelines. Today I was researching split/shared E/M on the inpatient side and ran across the following from Medicare.
"to bill a Level 5 new patient visit, the history must meet CPT's definition of a comprehensive history"
"The comprehensive history must include a review of all the systems..."
link to the full document the above is from the last page
http://www.cms.hhs.gov/transmittals/downloads/R178CP.pdf
This made me look at CPT's definition. Sure enough CPT's definition states "Comprehensive: Chief complaint; extended history of present illness; review of systems that is directly related to the problem(s) identified in the history of present illness plus a review of all additional body systems; complete past, family, and social history."
The 97 guidelines state at least 10 systems count as comprehensive.
Who trumps who? Based on their wording, it looks like, for Medicare, CPT definition would override the 97 guidelines.
Any insight or opinions are greatly appreciated.
Thanks
Laura, CPC
"to bill a Level 5 new patient visit, the history must meet CPT's definition of a comprehensive history"
"The comprehensive history must include a review of all the systems..."
link to the full document the above is from the last page
http://www.cms.hhs.gov/transmittals/downloads/R178CP.pdf
This made me look at CPT's definition. Sure enough CPT's definition states "Comprehensive: Chief complaint; extended history of present illness; review of systems that is directly related to the problem(s) identified in the history of present illness plus a review of all additional body systems; complete past, family, and social history."
The 97 guidelines state at least 10 systems count as comprehensive.
Who trumps who? Based on their wording, it looks like, for Medicare, CPT definition would override the 97 guidelines.
Any insight or opinions are greatly appreciated.
Thanks
Laura, CPC