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Thread: 95 or 97 guidelines

  1. #1
    Join Date
    Apr 2007

    Default 95 or 97 guidelines

    AAPC: Back to School
    When auditing one physician with multiple patients is it ok to switch between the 95 and 97 guidelines to benefit the physician.

    I know you can not combine the guidelines per patient visit, but can you use 95 guidelines for one visit and on the next visit (same patient/same physician) use 97?

    Thank you

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Yes...as long, as you have already stated, you don't combine the DG within the patient encounter and if you're practice doesn't have a policy to use a certain set.

    "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)."


  3. #3


    you need to check your compliance plan to ensure that it isn't specific to which set of guidelines your practice will use.
    Danielle Carroll, CPC

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