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"Most advantageous to the physician"


True Blue
East Greenbush, NY
Best answers
I know that when deciding to use either 95 or 97 guidelines, you are supposed to use the one that is "most advantageous" to the physician. However, when doing an audit or review, how do you determine which one? Do you review each note with both and choose that one that is the higher level? Or maybe the one that matches what the physician chose so as to get a better compliance percentage?

Also, we have this situation where our encoder in eCW will suggest codes to physicians using 97 guidelines. Some use it, some don't. Should we be using 97 due to this?

My hang-up is "most advantageous." In the case of an audit or internal review, is "most advantageous" the higher level resulting in higher reimbursement or that which will give a better compliance rate?