Wiki E & M Examinations

Easley, SC
Best answers
Is it okay to use the 1995 guidelines for coding the examinations on New Patients and use the 1997 guidelines for coding the examinations on Established Patients?

I work in Rheumatology and the examination for our Established Patients is primarily of the joints and using the 1995 guidelines, that is only 1 organ system, but the 1997 Musculoskeletal Examination, I can get enough bullets for Expanded Problem Focused and Detailed examinations.

If we can only use one or the other guidelines, do you have any suggestions?

Your assistance is very much appreciated.

Thank you,

Candice Brazeale, CPC
You can use one or the other. Whichever is most beneficial for the patient you are reviewing at the time. I mainly use the 95 guidelines but for my Rheumatologists, depending on their dictation, sometimes it gives them more credit for all their work to use the 97 guidelines. It just depends how detailed their musculoskeletal exams get...

You're a gem. Thank you so much. Maybe you can look at my other question regarding diagnosis. We are getting ready for RAC and I am auditing charges already billed. Do you know of a good auditing book? Maybe we could exchange email addresses. Mine is

Thanks Again,

Candice Brazeale, CPC

Candice, Good luck with your auditing. :) I've been auditing for a while but did recently get an E/M auditing book to check out:
I thought it was good though pretty basic, for me anyway. I have found that some of the best information is from the CMS guidelines, specialty societies' websites, Medicare carriers' websites, coding websites and, of course, forums like this one!
Last edited: