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Practice Using 95 & 97 Guidelines??

  1. #1
    Default Practice Using 95 & 97 Guidelines??
    Exam Training Packages
    Hello,
    Does anyone know of any reasons why one practice can't use both auditing guidelines? If one physician prefers 95 guidelines and another prefers 97, is that a problem?
    Thanks,
    Sue

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default You can use BOTH guidelines
    You can use BOTH 1995 and 1997 guidelines in your practice. You can even switch back and forth depending on which is more advantageous for a given service.

    You CANNOT use BOTH guidelines on the same note. (i.e. use the 1997 guidelines for the History, and 1995 guidelines for the exam).

    So if I understand your question correctly, yes, Dr A in the practice can use 1995 while Dr B in the same practice uses 1997; there is no problem at all with this scenario.

    F Tessa Bartels, CPC, CPC-E/M

  3. #3
    Default
    Thanks for your insight. It looks like I'm going to have to brush up on the 97 guidelines!

  4. #4
    Location
    Chicopee, MA
    Posts
    15
    Default
    You can use both, but I was told it was wise to choose one set and stick to it. Having 14 physicians, it was better for me to have them on the same page when documenting exam elements. Working in pain we benefitted more by using the 95 guidelines. Getting the physicians to document each extremity upper/lower left/right was a pain in the ass.
    Tarringo T Vaughan BA, CPC
    Director of Pain Management
    Billing Services

  5. #5
    Location
    San Gabriel Valley
    Posts
    31
    Default practice 97 95 guidelines
    You could use either 97 or 95. I really don't think you could use both. It would be crazy to keep track who is using what.

    We use the 95, our ortho just started using 97. They are a different specialty and it is much easier for them to use 97.
    We are changing to EMR.
    So it was decided to use 97 across the board.

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default You can use BOTH
    Rebecca,
    You don't have to keep track of who is using which guidelines, you just audit based on what is most advantageous to each note.

    Your ortho specialist might want to use 1997 specialty exam, but your family practice might prefer 1995 guidelines. That's perfectly okay.

    We're a very large practice, and while we generally follow 1995, and our provider compliance training focuses on 1995 guidelines. But if 1997 works better for a note we allow 1997. Our compliance plan specifically states that we will use whichever is best for the service provided.

    F Tessa Bartels, CPC, CEMC

  7. #7
    Default
    Quote Originally Posted by FTessaBartels View Post
    Rebecca,
    You don't have to keep track of who is using which guidelines, you just audit based on what is most advantageous to each note.

    Your ortho specialist might want to use 1997 specialty exam, but your family practice might prefer 1995 guidelines. That's perfectly okay.

    We're a very large practice, and while we generally follow 1995, and our provider compliance training focuses on 1995 guidelines. But if 1997 works better for a note we allow 1997. Our compliance plan specifically states that we will use whichever is best for the service provided.

    F Tessa Bartels, CPC, CEMC
    The office I now work for had trained the physicians using the "bullet exam" so I thought I had to use those guidelines, when I talked to the corporate coder she said I could use whichever I wanted and whichever would benefit the doctor.

    They trained them that way so that no matter which guidelines an insurance company used they could "pass".
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    Tessa is absolutely correct.........

    "Currently, (as of November 2005) carriers are to continue reviews using both
    the 1995 and 1997 Documentation Guidelines for E&M Services (whichever
    is more advantageous to the physician
    ) until further notice."


    -1995 Documentation Guidelines for Evaluation and Management Services
    -1997 Documentation Guidelines for Evaluation and Management Services


    http://www.cms.hhs.gov/MLNEdwebGuide/25_EMDOC.asp

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