Comparison of 1995/1997 E/M Guidelines vs. E/M 'New Framework' Guidelines

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article compares the 1995 and 1997 evaluation and management guideline structure with the American Medical Association CPT Panel’s later recommendations for a new framework. It is useful for coders, auditors, compliance staff, and clinicians who need a high-level view of how E/M documentation expectations are organized across versions and what kinds of history, exam, and medical decision-making topics are addressed.

Why This Topic Matters

E/M documentation requirements affect code selection, compliance review, and record completeness. Understanding how guideline frameworks differ helps readers evaluate charting expectations and prepare for changes in documentation policy.

Article Sections

  1. Comparison overview

    Introduces the side-by-side comparison of multiple E/M guideline versions and frames the scope of the discussion.

  2. History

    Summarizes the major history elements discussed across the guideline versions, including the general organization of history components.

  3. Review of systems (ROS)

    Compares how review-of-systems requirements and levels are organized across the versions discussed in the article.

  4. Past/family/social history (PFSH)

    Outlines the general treatment of past, family, and social history across the guideline sets.

  5. Elements (HPI, ROS, PFSH)

    Describes how the history categories are combined and what general completeness concepts are referenced.

  6. Four types of history and criteria

    Presents the overall history-level framework used to compare the guideline versions.

  7. Physical examination types

    Reviews the broad categories used to describe physical examination structures in the guideline versions.

  8. Levels

    Summarizes the level-based organization used in the physical examination comparison.

  9. Criteria for 4 types of physical examination

    Compares the general criteria framework for physical examination levels across the versions.

  10. Medical decision-making

    Outlines the medical decision-making framework and how complexity is structured in the comparison.

  11. Categories

    Identifies the broad decision-making categories referenced by the article and compares how they are presented in each guideline version.

  12. Counseling and/or coordination of care

    Summarizes the general time-based counseling and coordination-of-care guidance discussed in the comparison.

What You Will Learn

  • How the article compares E/M guideline versions
  • How history components are organized across guideline frameworks
  • How review of systems and past/family/social history are categorized
  • How physical examination and medical decision-making are structured in the comparison
  • What general topics are addressed in time-based counseling and coordination guidance

Who Should Read This

  • Medical coders
  • Compliance staff
  • Auditors
  • Physicians and other clinicians
  • Revenue cycle professionals

Code Ranges Discussed

  • CPT: 99231–99233
  • CPT: 99271–99263
  • CPT: 99301–99302
  • CPT: 99311–99313
  • CPT: 99331–99333
  • CPT: 99347–99350

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