Combined use of 95 & 97 DG in EM
level selection - Different views from different carriers...
Based on my experience, most of the provider’s documentation will
hit the high level of EM service only when you use Exam specified in 95 DG &
HPI specified in 97 DG.
In the past few years, I have been searching to get proof regarding
combined use of 95 and 97 DG...but never got an official confirmation from CMS
resource.
Now we can find an official statement from CMS in the below path
which confirms to combine both 95 and 97 DG for EM level selection.
Not sure when it was posted in CMS web page.....but
states”....services performed on and after September 10, 2013”
Below is the Q & A from CMS:
FAQ on
1995 & 1997 Documentation Guidelines for Evaluation & Management
Services.
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.
