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1997 guidelines

  1. Default 1997 guidelines
    Exam Training Packages
    Hello everyone, I need some help with the 97 guidelines, where I work we use 95 but now we have auditors that are using both 97 and 95 and I don't know alot about the 97 guidelines also I am sitting for the CEDC in 2 weeks (short time left i know) and would really like as much info as I can especially about the bullets and chronic problems.

    1st for the status of 3 chronic problems can the DR. just say in hpi that pt has htn,dm and seizures or does he have to describe if still has or they are resolved anything in that nature?
    2nd the bullets does that mean like say the cardiovascular section in the exam portion if they have the rate and rythm checked and something else checked in that box that it then counts as 2 bullets?
    Please any and all help is truly appreciated..alice

  2. #2
    I used the 95 guidelines for the CEDC exam. I brought the 97 guidelines but didn't use them. I am surprised your auditors are encouraging the use of the 97 gls unless the encounter is for an eye or psych problem.

    Take an audit tool that you are comfortable using because you will need to determine scores of E/M levels. I had worked for a company that used a reference tool to assign ED levels. Although managment said it was only a tool, they utilized it exclusively, audited their coders by it resulting in the coders' inability to code E/M levels compliantly. I had to purge that methodology.

    Review the ROS requirements, especially the documentation for a complete ROS. There can be differences with the requirement for a detailed exam when using the 95 gls. Look for the elaboration of the elements for an extended exam.

    The provider needs to elaborate on the chronic conditions, not just list them.

    The 97 gls have specific bullets required for documentation. The heart or pulse rate is only one measurement of three required for one bullet in the Constitutional system.

    Study the critical care services and good luck with the exam.

  3. Default Re-1995
    thank you so much for the help it is really appreciated. do you know where I can fiind anything on incident to? I really don't know a whole lot about that?.. thanks again for the help..alice

  4. #4
    Alice, are you referring to a shared/split service in the ED? If so, shared services cannot be billed with critical care services or procedures. The ED physician must participate in a face-to-face and the documentation must show that all or a portion of the history, exam or MDM was perfomed by the physician in order to bill under the physician's number when shared with a mid-level provider.

    Per CMS:
    Hospital Inpatient/Outpatient/Emergency Department Setting
    When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP's UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.

    ACEP has a Mid-level FAQ:

    Additional ED info can be found on the ACEP site:

  5. #5
    Milwaukee WI
    Default status of 3 chronic conditions
    The physician must document the STATUS of each of at least three chronic conditions - using words such as: stable, improved, worsening, well-controlled, etc

    Simply giving a laundry list of chronic conditions will NOT satisfy the 1997 guidelines for HPI.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. Default Re-1997 guidelines
    Thank you everyone for your responses it does help alot I really do appreciate all the help..alice

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