Beware the 1995 vs. 1997 guidelines pitfall by choosing just one at a time. When selecting an E/M code for an office visit there are multiple factors -- and when you throw in two sets of physical examination guidelines, your head can spin. Let our experts take the confusion out of the 1995 versus 1997 guideline debate with these top four exam questions. 1. How Do I Determine the Physical Examination Level? There are two sets of guidelines you should be familiar with before trying to determine the level of the physical examination key component for your E/M coding: 1995 and 1997 guidelines. Both sets of guidelines help you determine which of the following four levels of examinations your physician completed during an E/M service: problem-focused, expanded problem focused, detailed, and comprehensive. The level of exam is a factor in determining which code you can report: 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components ...) for new patients or 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components ...) for established patients. 2. What's the Difference Between 1995 and 1997 Guidelines? The exam element is the most significant difference between the two sets of guidelines. 1997: 1995: 3. Which Guidelines Should I Use? You don't have to pick one set of guidelines and stick with them every time you code an E/M service. You can switch between 1995 and 1997. "Given that per Medicare, 'carriers and A/B Medicare Administrative Contractors are to continue reviews using both the 1995 and 1997 documentation guidelines (whichever is more advantageous to the physician),' physician practices are not restricted to using only one of the guidelines," says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. You can choose whichever set of guidelines is most advantageous for each encounter, says Suzan Berman, CPC, CEMC, CEDC, senior manager of coding education and documentation compliance with UPMC in Pittsburgh, Penn. Essential: Caution: Bottom line: 4. Can My Physician Use a Template for Exam Documentation? Having your physician use a paper template or one within your EMR can be helpful to ensure he captures every piece of his exam, but use caution. "Templates are a good way to ensure capturing of all elements of the exam, but physician training can help with this also," Boone says. "If you do use a template it really is a good idea to tailor it to the specialty." "Templates can be useful as long as they are not abused," Bucknam agrees. "The appropriate exam is the exam that the physician thought was needed in order to appropriately assess the patient's presenting problem. Putting in a bunch of other useless stuff is inappropriate." Warning: