Physicians (and other qualified health care professionals) who provide evaluation and management (E/M) services have the choice of using the 1995 or 1997 version of documentation guidelines published by the Centers for Medicare & Medicaid Services (CMS). (Readers can find copies of the 1995 and 1997 guidelines online at https://www.aap.org/en-us/professional-resources/practice-support/Coding-at-the-AAP/Pages/Evaluation-and-Management.aspx.) Knowledge of each guideline allows a physician to use the most favorable guideline in selecting the code that best represents the level of E/M service performed and documented. So what are the differences between the 1995 and 1997 guidelines? There are 2 key differences.

Because the CMS and most payers treat the guideline for an extended HPI the same whether using the 1995 or 1997 guidelines, the examination becomes the significant difference between the 2 guidelines.

While this article will focus on differences between the 1995 and 1997 examination guidelines, there are some key guidelines that apply when using...

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