Outpatient Facility Coding Alert - 2018 Issue 8
You Be the Coder: Choose 1995 or 1997 Based on Exam, Encounter
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Article Overview
This article discusses how the 1995 and 1997 evaluation and management documentation guidelines differ, with emphasis on the examination portion of the record and how documentation approach can affect code selection. It is aimed at coders, billers, and providers who work with E/M services and need to understand when one guideline set may be more practical than the other. The article also references Medicare documentation guidance and a limited exception involving history documentation.
Why This Topic Matters
Understanding the distinction between the 1995 and 1997 E/M guidelines helps practices evaluate their documentation workflow and align encounter-level coding with the guideline set that best fits the provider’s exam style and recordkeeping system.
Article Sections
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Question
Introduces the reader’s question about whether one E/M guideline set is better suited to a specialty’s exam documentation needs.
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Answer
Summarizes the general distinction between the two guideline sets and frames the discussion around exam-level selection.
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1997
Describes the 1997 documentation framework for examination elements and its structured approach to exam reporting.
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1995
Describes the more general 1995 documentation framework and how it differs in flexibility for exam documentation.
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Essential
Addresses how the guideline sets may be applied within a single encounter, including a Medicare-related documentation note and an exception involving history documentation.
What You Will Learn
- How the 1995 and 1997 E/M guidelines differ in general approach
- Why the examination component is central to guideline selection
- How documentation style can affect exam-level assessment
- How Medicare guidance relates to use of the documentation guidelines
- What broad factors may influence a practice’s choice of guideline set
Who Should Read This
- Medical coders
- Professional billers
- Physicians and other providers
- Practice managers
- Compliance staff
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