Outpatient Facility Coding Alert - 2014 Issue 8
News You Can Use: Calculate HEM with Less Effort, Thanks to Guidelines Change
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Article Overview
This article covers a CMS and HHS documentation update affecting Evaluation and Management service reporting, with emphasis on history-of-present-illness documentation and the relationship between legacy guideline sets. It is aimed at coders, auditors, compliance staff, and providers who need to understand which guideline elements may be used together for office and other E/M services. The discussion also notes how payer recognition may vary and why practices should verify applicability with individual contractors and plans.
Why This Topic Matters
The update can affect how organizations assess documentation completeness and support E/M level selection. Understanding the scope of the change helps coding and audit teams align documentation review processes with current payer expectations.
Article Sections
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Guideline update overview
Introduces the documentation change and its impact on selecting and evaluating the history component for Evaluation and Management services.
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Refresh your 95 vs. 97 HPI knowledge
Reviews the two guideline frameworks for history-of-present-illness documentation and the general way they categorize history detail.
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Get to know the change
Explains the updated flexibility in combining history and examination guideline sets for services performed on or after the stated effective date.
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Pointer
Notes payer and contractor recognition considerations and the need to confirm how the guidance is applied in practice.
What You Will Learn
- How the documentation update affects Evaluation and Management history assessment
- The general relationship between legacy guideline sets for history and examination
- Why payer verification is important when applying updated documentation guidance
- How the change may influence coding review and audit workflows
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physician office staff
- Clinical documentation reviewers
- Providers
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