Medical Management Associates
Ask-A-Consultant: E&M Coding
I am the administrator for a 4 physician practice. My physicians are really
confused about the various documentation guidelines for evaluation and
management services and donít know which ones to follow. One of the physicians
is still utilizing the 1994 guidelines, 2 are utilizing the 1997 guidelines and
one just codes whatever he feels like his visit is worth. Which set of guidelines
do you recommend?
As you know, every evaluation and management service is made up of three key
components: history, examination and medical decision making. The only difference
between the 1994 and the 1997 guidelines is in the examination component.
This program has prior approval by the American Academy of Professional Coders
for 3 continuing education hours.
Granting of prior approval in no way constitutes endorsement by AAPC of
the program content or the program sponsor.
The 1997 guidelines consist of 11 specialty examinations and one general
multisystem examination. Each have specific elements that must be documented for
a specific level of examination (problem focused, expanded, detailed or
comprehensive). In contrast, the 1994 guidelines are much more general and are
based upon body areas and systems, but not specific elements of the body area/system.
Many of the specialties prefer the 1997 guidelines, as they are much more
explicit about the information that is required. One can simply count the number
of elements documented to arrive at the level of service for the examination
component. On the other hand, many primary care physicians, particularly
pediatricians, prefer the 1994.
Since the evaluation and management services documentation guidelines are still
under evaluation and revision, neither the 1994 nor the 1997 guidelines are final.
Therefore either set may be utilized. We advise practices to allow their
physicians to utilize the guidelines with which they are most comfortable. The
most important thing to remember is that everyone in the practice should be
consistent with the particular set of guidelines chosen. In fact, in the event
of an audit by your Medicare carrier, both sets of guidelines will
be utilized. Auditors are instructed to utilize the guidelines that are most
beneficial to the practice.
Mary Beth Black, CPC (bio...)
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