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Thread: 1997 versus 1995 DG

  1. #1

    Default 1997 versus 1995 DG

    AAPC: Back to School
    We have a provider whose documentations qualifies for 99204-1995 DG,but
    we're following the 1997 DG in this practice.I feel sorry for him,so can we use
    1995 DG for his new visits (EXCLUSIVELY FOR HIM NOT INCLUDING THE OTHER PROVIDERS) and 1997 DG for his established visits along with the other providers (NEW AND ESTABLISHED VISITS)?
    Thanks again in advance and "HAPPY HOLIDAYS" to everyone.
    This FORUM helps me a lot!

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Carriers and A/B Medicare Administration Contractors (MACs) are to continue reviews using both the 1995 and 1997 Documentation Guidelines for E&M Services (whichever is more advantageous to the physician).

    You select whichever DG is more advantageous for that provider, for that visit, for that day.


  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Unless

    Rebecca is correct ... BUT

    If your practice has a specific policy in place that states you will use 1997 DG only, then I'd advise that your follow that policy.

    When an auditor arrives one of the things they request is the practice's policy on guidelines and auditing.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007
    North Carolina


    Good point, Tessa. I am curious though...for those of you that have a specific set of DG's that your practice follows, do you not allow some leverage within your policy to accomadate certain physicians documentation practices? If it's not contracted " in stone" within the carrier in question, why would you require the physician to follow one set of standards..especially in light of all the changes to follow?

  5. #5

    Default 1997 vs. 1995 DG

    Rebecca and Tessa,
    Thank you very much for your prompt reply.Believe it or not I've been in this field for 10 years but never went to this FORUM not knowing how informative and helpful it is.More power to AAPC especially to the moderators and members who devote their time and effort to this FORUM.
    We'll follow strictly 1997 DG.

  6. #6
    Join Date
    Apr 2007


    We follow only 97 guidelines here. This is not my decision this is a corporate decision.

    I will admit to bending the rule in one situation and it is very rare that I do this. The initial inpatient admit. If they don't meet the requirements for the lowest level will bill with 99499. If they don't meet them because of the exam portion based on 97 I will use 95 guidelines. Like I said this is rare, usually they don't meet based on history as well so it is not an issue, occasionally they will be short a bullet or 2 so we use 95 instead of the unlisted.

    This is the only time we bend the rule.

    Laura, CPC, CEMC

  7. #7

    Default 1997 vs 1995 dg

    Hi Laura,
    Thanks for the in-put but we're doing out-patient clinic visits.So, do you think
    we'll use 1995 rarely too if documentations not enough to support for 1997 DG?
    By the way,can we count as ROS if in the HPI the doctor review the lab.result as negative for chlamydia as IMMUNOLOGIC or ENDOCRINE?
    Thanks again!

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