# 95 & 97 documentation guidelines for  E & M services



## cynthiaarellano14@yahoo.com (Mar 10, 2015)

just wondering if anyone knows if you can mix & match on the 95 or 97 documentation guidelines?, in other words would a provider be able to use the 97 documentation guidelines for an extended HPI and the 95 guidelines for other elements such as the exam portion when documenting E & M services (same encounter)? Thanks in advance for any help I can get 
. Cindy   can I get a senario ????????????


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## bharathi kuppa cpc (Mar 10, 2015)

The provider can not use both 95 and 97 guidelines for a single encounter


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## lgardner (Mar 10, 2015)

From the October 2013 issue of Coding Edge (page 9):

The Centers for Medicare & Medicaid Services (CMS) has revised its Documentation
Guidelines for Evaluation and Management (E/M) Services to allow physicians to use an extended
history of present illness (HPI), as defined by the 1997 guidelines, with the other
elements of the 1995 guidelines. This means that, effective Sept. 10, “the status of three or
more chronic conditions” qualifies as an extended HPI for either the ’97 or ’95 guidelines.
CMS announced the change in a FAQ on 1995 and 1997 Documentation Guidelines
for Evaluation & Management Services (www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/PhysicianFeeSched/Downloads/EM-FAQ-1995-1997.pdf):
Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation
and Management Services to document their choice of evaluation and management
HCPCS code?
A. For billing Medicare, a provider may choose either version of the documentation
guidelines, not a combination of the two, to document a patient encounter. However,
beginning for services performed on or after September 10, 2013 physicians
may use the 1997 documentation guidelines for an extended history of present illness
along with other elements from the 1995 guidelines to document an evaluation
and management service.
The change doesn’t allow physicians to document less, but it does allow greater flexibility
in applying the ’95 guidelines.
“Now, physicians can use 1995 Exam and status of the three chronic conditions, rather than
having to document four or more of the eight HPI elements, as required by the ’95 guidelines,”
explains Elin Baklid-Kunz, MBA, CPC, CCS, who first heard about the change
at a Medicare administrative contractor (MAC) advisory group meeting in late August.
“I personally feel, and I think many agree with me, that this will have a very positive impact
for physicians who prefer to use the 1995 exam—and especially for family practice
and internal medicine, as physicians in these specialties manage the patient’s chronic conditions,”
said Baklid-Kunz.
CMS will issue a change request and update E/M guidelines to reflect this policy change.


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## cynthiaarellano14@yahoo.com (Mar 11, 2015)

Thank you so much for you help.


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## BenCrocker (Mar 11, 2015)

I tend to use both and then see which version is more favorable to the physician. As long as it meets medical necessity and the documentation.


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