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95-97 Coding Guidelines for E&M levels

  1. #1
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    Question 95-97 Coding Guidelines for E&M levels
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    I (and lots of people I work with or have worked with in the past)have been under the impression that a coder had the choice of using the 95 or 97 guidelines when coding office visits within a single clinic. I have searched in my CPT book for guidance, it seems to follow the 97 set-(constitutional symptons on inclusive to the ROS)

    In a recent encounter with another coder, she stated the clinic had to decide on one set of guidelines and not use either/or. She is presently working for a clinic that goes by 95 guidelines only and has a part-time at home job for a clinic that goes by the 97 guidelines only.

    Does a decision have to be made for one set or the other?

  2. #2
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    Quote Originally Posted by chenson384 View Post
    I (and lots of people I work with or have worked with in the past)have been under the impression that a coder had the choice of using the 95 or 97 guidelines when coding office visits within a single clinic. I have searched in my CPT book for guidance, it seems to follow the 97 set-(constitutional symptons on inclusive to the ROS)

    In a recent encounter with another coder, she stated the clinic had to decide on one set of guidelines and not use either/or. She is presently working for a clinic that goes by 95 guidelines only and has a part-time at home job for a clinic that goes by the 97 guidelines only.

    Does a decision have to be made for one set or the other?
    I've heard of some offices/clinics who do have a guideline they follow for what DG they use at their facility/office.

    It would be up to the office/facility but you would want to check with your carrier if they use a specific one. I know my local Medicare Carrier uses the one that will benefit the provider.
    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"

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