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Oncology & Hematology Coding Alert

E/M Coding:

3 Questions Get to the Heart of Physical Exam Guideline Options

Published on Fri Aug 05, 2011

1995 vs. 1997 guidelines: Limit yourself to one set per claim.Whether you need a quick link to 1995 and 1997 E/M guidelines or a refresher on how the guidelines differ for the exam component, the answers to three FAQs can help keep your physical exam selection on track.1. Where Do I Find Exam Level Guidelines?There are two sets of guidelines you should be familiar with before trying to determine the level of the physicalexamination key component for your E/M coding: 1995 and 1997 guidelines. You may download them from www.cms.gov/MLNEdWebGuide/25_EMDOC.asp. Either set of guidelines can help you determine which of the following four levels of examinations your oncologist completed during an E/M service: problem-focused, expanded problem-focused, detailed, and comprehensive.Understanding the guidelines is important because the level of exam can be a factor in many E/M codes, such as outpatient/office codes 99201-99205 (Office or other outpatient visit for the evaluation [...]
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