Wiki E&M coding

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cynthiar

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Please advise if members that are doing chart reviews, use 1995 or 1997 guidelines, or both. I prefer the 97 because they require bullets, and I think that the 1995 gives the physician too much leeway in doing their E&M coding. Please let me know any of your thoughts on this or documentation as to which exam guidelines we should use.
Thanks
Cynthia Robinson
 
I also prefer the 1997 guideline and teach the physicians I work with to document using the 97 Cardiovascular exam. However if Medicare or other payors audit a claim they are to use both and allow with ever is most advantageous for the physician.
Crisan Houston
 
cynthiar said:
Please advise if members that are doing chart reviews, use 1995 or 1997 guidelines, or both. I prefer the 97 because they require bullets, and I think that the 1995 gives the physician too much leeway in doing their E&M coding. Please let me know any of your thoughts on this or documentation as to which exam guidelines we should use.
Thanks
Cynthia Robinson
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We train our physicians from the 97 DG's, but when we do internal audits we use whichever benefits the physician. I know that most of our carriers follow whichever benefits the physician when it comes to the exam.

My local Medicare carrier has made it easier to use the 95 DG's for the exam and have it listed on their website and whenver they do educational training the discuss it too.
 
I use whatever is most advantageous to the provider. If you are auditing Family Practice or Internal Med, I think that the providers are getting "short changed" if you only use 97 guidelines. I know that they are not black and white, but in certain cases, the 95 guidelines will be more beneficial to the provider.
 
I was a compliance auditor at my former position at a large teaching hospital, we always used the guidelines that best fits the physician/NPP documentation. Whether you think it gives the physician/NPP too much leeway is not up to you, it is up to the people making the rules. In my experience, the '97 guidelines work best for certain specialties such as opthalmology, psych, and ENT where the exam is very specialized. The '95's are much more generalized which works best for most other physicians/NPP's. In reality, the main difference between the two is the exam.
 
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