decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 7 (July)
Ask Margie: Selecting 1995 vs. 1997 E/M guidelines
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Article Overview
This article reviews the relationship between the 1995 and 1997 E/M documentation guideline sets and discusses how CMS guidance affects their use in evaluating examination documentation. It is aimed at physicians, coders, auditors, and compliance staff who need to understand how documentation support is assessed under different guideline frameworks. The article includes general discussion of exam structure, carrier review practices, and illustrative scenarios across common outpatient and orthopedic contexts.
Why This Topic Matters
Understanding the differences between the 1995 and 1997 E/M documentation guideline frameworks helps practices interpret documentation support consistently and align internal review processes with payer expectations.
Article Sections
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Question
Introduces the documentation guideline selection issue and frames the main question addressed by the article.
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Answer
Summarizes the general guidance on how the documentation guideline sets are reviewed and applied in practice.
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Examples and comparisons
Provides comparative illustrations of exam documentation under the two guideline frameworks in different clinical situations.
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Official resources
Lists referenced CMS and OIG source materials for further review.
What You Will Learn
- How the 1995 and 1997 E/M documentation guideline sets are discussed in relation to documentation review
- What types of exam documentation structure are compared across the two guideline frameworks
- Which kinds of clinical scenarios are used to illustrate documentation support
- What official reference materials are cited for further information
Who Should Read This
- Physicians
- Medical coders
- Compliance staff
- Audit staff
- Billing personnel
Codes Discussed
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