Wiki why use the 1995 Medicare guidelines over 1997?

[The Angel Of the South]

In continuing to study E-and-M as the area of coding I need the most work on, I read "Coding for the physical exam may vary, depending on whether the physician is using CPT guidelines, Medicare's 1995 guidelines or Medicare's 1995 guidelines." Yeah, I at least knew that already--that both seem to be used; but why? With the 1997 guidelines existing, why would anyone use 1995 even if permitted? It's been 27 years, so anyone who was in medical practice in 1995 has had plenty of time to learn the 1997 guidelines. If the 1995 guidelines haven't been declared officially out of use by Medicare, why not?

 

[Orthocoderpgu]

The difference between 95 and 97 are virtually non existent other than the exam. The provider is almost always better off using 95 guidelines. The reason for it is the exam. You can get a detailed exam easier in 95 than you can with 97. I'm almost positive that the 95 guidelines were developed with internal med providers in mind. However those guidelines are difficult to apply to other specialties which is why the 97 guidelines were developed. The 95 was criticized for being "too broad" and 97 was criticized for being "too detailed". I coded E/M for years. If you are not using 95 there is a very good chance that you are short-changing your providers. In 97 an internal med doc would almost never get a 99214 because they would rarely perform such an extensive exam on so many body areas or bullets.

 

[csperoni]

I totally agree here with @Orthocoderpgu. I once had it explained to me as Medicare came out with the 1995 guidelines. There were some subspecialties who do a very detailed examination, but of a very specific body part. Think ophthalmology for example. They might spend 10 minutes examining your eyes, but don't listen to your heart, lungs, etc. With 1995 guidelines, it was almost impossible for some of these subspecialties to code 99204. So to accommodate for this, Medicare then came out with 1997 guidelines, not as a replacement, but as an alternative.
I can't wait for 2023 when I have heard that even inpatient is transitioning to the 2021 guidelines.