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Phyllis Silver said:
this may sound like a dumb question, but what are the coding guidelines for 1995/1997, please explain
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Not stupid at all! This is how we learn and we have all been there. They are a set of guidelines created by CMS (Medicare) to govern E/M coding. E/M coding is VERY confusing and takes quite some time to master (if anyone actually ever does master it..haha). They were first created in 1995 and then updated in 1997 and both are acceptable to use to help you code E/M. It is safe to say that normally you would pick one standard out of the two and stick with that so if your charts are ever audited then your records are consistent and also, then they will know which guidelines you go by and how to better audit your work. I have been told at seminars that the 1997 guidelines seem to be more commonly used by most clinics because they are easier to use, however, most auditors go by the 1995 guidelines, as they are believed to be more specific...by who, I do not know. There are also audit tools out there that incorporate these guidelines, such as the Marshfield audit tool, which you can find online quite easily. These are a great tool for E/M coding when you're first starting out and might be worth looking into to help you learn some of this stuff. Hope I helped a little
 
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