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Thread: Non-Medicare E/M billing

  1. #1

    Default Non-Medicare E/M billing

    AAPC: Back to School
    If you do not bill Medicare do you have to follow the 1995 or 1997 guidelines or can you produce your own matrix to follow in your compliance plan?
    Where can I find information about this? It seems everything talks about billing 1995 or 1997 but I haven't run across an article that states you don't have to follow either if you aren't billing Medicare.

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    You have to follow one or the other in order to follow CPT guidelines as they tell you what type of history, exam, and MDM you need for each level of E/M.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    Quote Originally Posted by Lisa Curtis View Post
    You have to follow one or the other in order to follow CPT guidelines as they tell you what type of history, exam, and MDM you need for each level of E/M.
    I just want to clarity what Lisa has to say. For Patient A's documentation, you can follow either the 95 or 97 guidelines, whichever works best for your provider. You don't have to pick one or the other for your entire practice. If it works better to use a different guideline for Patient B's, you should use that. I'm not sure if I'm doing a very good job of explaining this. Anyone have a better way to explain it?
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    ccrsconsulting.com - website

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