ED Coding & Reimbursement Alert - 2017 Issue 3
Reader Question: Choose 1995 VS. 1997 Guidelines Per Encounter
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Article Overview
This reader question addresses documentation guidance for evaluation and management coding, focusing on the relationship between the 1995 and 1997 guidelines and a CMS policy update tied to services performed on or after September 10, 2013. It is relevant to coders, auditors, compliance staff, and providers who document E/M services and need to understand general payer policy differences and documentation framework choices. The article discusses the overall policy context, the timing of the CMS change, and factors to consider when working with different payer rules.
Why This Topic Matters
E/M documentation rules affect how encounters are supported in the medical record and how coded service levels are determined. Understanding the applicable guideline framework helps reduce compliance risk and supports more consistent documentation review.
What You Will Learn
- How the 1995 and 1997 E/M documentation guideline frameworks relate to one another
- What CMS policy change is discussed in connection with documentation guideline selection
- Why payer-specific rules still matter when applying documentation guidance
- What general factors influence choosing a documentation guideline set for an encounter
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Physicians and other providers
- Billing staff
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