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E/M Coding Guidelines "95" or "97"

  1. #1
    Lightbulb E/M Coding Guidelines "95" or "97"
    Medical Coding Books
    Hope someone can help me with this. We just recently switched to a new system. The EHR uses "97" guidelines and our physicians are not liking it to well they feel that it is harder for them to get a higher E/M level. They are a group of Ortho Doctors with some specialist in podiatry, hand surgery and plastic surgery. The doctors are wanting to switch back to the "95" guidlines because they feel it is easier to get a higher E/M level. We have been using the new system for well over a month and to me to switch now would be a little crazy. So which guidlines are better for a specialty group of doctors??????

  2. #2
    Location
    Salt Lake City
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    97 is better for a specialty group they can hit more bullets than organ systems. I am currently working with a neuro group that has decided to use the 97 guidelines because the only systems they exam are neuro and muskuloskelatal and it is easier for them to hit the 12 bullets than the 5-7 organ systems.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Location
    Manhattan, NY
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    390
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    The only difference between the two is the exam, and from what I understand, the 1997 guidelines are suppose to be better suited for a complete system exam. BUT, (always a but), if their process/habit of examining the patient fits the 1995 guidelines and the physicians are unwilling to change/revise the method of processing an exam, then you may have to comply with their wishes. There might be other areas of concern, but if an outside audit is done, they are suppose to use the guidelines that is best for the provider.

  4. #4
    Location
    Ellenville, New York
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    1,176
    Default Hpi
    There is another difference - the 1997 guidelines also allows a complete HPI if the status of three or more chronic conditions are documented in the HPI. On another twist of this, depending on the MAC, one can use the 97 guidelines for the HPI and the 95 guidelines for the exam. These usually are the "easier" parts for physician documentation. As an example, here in NY the MAC, National Government Services, this mix and match of the two sets is allowed on the same patient encounter.

    I found this information on E & M University

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

  5. #5
    Location
    Columbia, MO
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    12,531
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    It is entirely possible that the EHR is using the generic body system, most are pre set up that way, you need your vendor to load in the orthopedic body system for the exam, then you will see that for ortho the 97 guidelines are much better.

    Debra A. Mitchell, MSPH, CPC-H

  6. Red face E/M coding guidelines "95" or "97"
    Quote Originally Posted by MnTwins29 View Post
    There is another difference - the 1997 guidelines also allows a complete HPI if the status of three or more chronic conditions are documented in the HPI. On another twist of this, depending on the MAC, one can use the 97 guidelines for the HPI and the 95 guidelines for the exam. These usually are the "easier" parts for physician documentation. As an example, here in NY the MAC, National Government Services, this mix and match of the two sets is allowed on the same patient encounter.

    I found this information on E & M University
    I'm in Arizona and also read this on the E/M University........Is anyone aware of our MAC Noridian allowing the use of the 97 guidelines for the HPI and then the 95 for the exam on the same patient.

  7. #7
    Location
    Everett, WA
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    886
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    I'll be checking into this as I'd like to know also. Isn't E/M puzzling enough utilizing the two sets of guidelines without imposing switching back and forth between the components of both? Very confusing indeed! Can we get more clarification on this? ---Suzanne E. Byrum CPC

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