Coding for evaluation and management (E/M) services is complex. Even the Centers for Medicare & Medicaid Services (CMS) have proposed that, due to the complexity of the 1995 and 1997 guidelines for documenting E/M services, new guidelines, and perhaps new codes, are needed. In the meantime, physicians and coders continue to have questions on how to select codes based on the current guidelines. Here are a few examples of questions about the guidelines.

No. You may choose to determine the level of examination based on the 1995 guidelines or the 1997 guidelines for each individual encounter but cannot use both for one encounter. Advice about choosing one set of guidelines was often given when the history component of the 1995 guidelines did not include credit for noting the status of 3 or more chronic or inactive conditions, as it does in the 1997 guidelines. Most health plans and auditors, including...

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