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95 or 97 guidelines

  1. #1
    Default 95 or 97 guidelines
    Medical Coding Books
    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
    North Carolina
    Default 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. Default
    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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