Forum - Questions & Answers
E/M Answer Book
I have a big binder " E/M Answer Book the complete educational & auditing tool" written by Nancy Maguire. It is one of the best resources I have ever purchased. Unfortunately, several of my pages are missing and I wanted to purchase another one but I do not know where to find it. If anyone can help me I would appreciate it.
E/m
The E/M Book was written while I was at DecisionHealth. To my knowledge they no longer publish the book.
Thank you very much
Nancy
E/M book
Not at this time
How many pages are missing?
E&M book
I am not the one with the missing pages. I was just interested in the book itself!
Extended HPI
I was recently at a seminar that quoted this book as saying the extended HPI in the hx portion of E?M is the same for 95 and 97. i.e. meaning the status of 3 chronic/inactive conditions is permissible for both set of guidelines.
I have audited in two states where the Medicare carrier used a tool that only allowed it for 97 guidelines.
Nancy can you verify, clarify any of this?
Thank you
Hpi
CMS will accept with either guideline--makes sense!!
"The 1997 DG state an extended HPI consists of at least four elements of the HPI or the status of at least three chronic or inactive conditions. The 1995 DG do not have this statement. However, WPS Medicare received clarification from CMS indicating this statement applies to both 1995 and 1997".
Hpi
The History component for the 1995 and 1997 Guidelines differ in that the 1997 allow the physician to receive "credit" for taking a history related to three chronic conditions versus commenting or documenting the characteristics of the current illness such as duration, timing, modifying factors etc. In some specialties, for example medicine, the documentaiton of the HPI for three chronic conditions may have more applicability than the specific characteristics of the current illness.
There are some specialties, for example, orthopaedics where it would be very rare for the surgeon to document a HPI for three chronic conditions. It may be at the seminar you recently attended, the instructor was using that as an example when explaining the difference for the 95 and 97 Guidelines. A physician may have asked what is the difference and the presenter may have used an example similar to this.
You are correct to question your perception of the presenters information. The E&M Guidelines 1995 and 1997 are found on the National Medicare website and typically all local carriers.
Visit www.karenzupko.com for more information on National Coding Courses sponsored by AANS, AAOHNS, ACS, ASPS, SVS, AAOS and presented by KarenZupko & Associates,Inc.
Mary LeGrand, RN,MA, CCS-P, CPC
KarenZupko& Associates, Inc
www.karenzupko.com
confused
HI Mary
I am not sure if I understand....
Are you agreeing or diagreeing wtih the statement "status of 3 chronic/inactive conditons" applies to both sets of guidelines?
My position is that if I am audiiting and I have the same tool the Medicare carrier is using, I better go by what they have. In this case I had better not be counting status of 3 for 95 guidelines.
I think their tool makes sense. It would seem relatively easy to get a higher level every time using 95 versus 97? with the limitation on the status of 3, it balances it out more??
But good for WPS getting it in writing. I just don't know if it would carry much weight when they want their money back?
Hpi
http://www.wpsic.com/medicare/part_b/education/evalmngmntqahistory.shtml
http://www.highmarkmedicareservices.com/partb/em/hpi-elements.html
Remember, these are Guidelines, not law. CMS realizes that chronic conditions and their management did not start in 1997! CMS is the last say and they have commented, more thanonce, that this management is acceptable for both sets of Guidelines.
Common sense has to have a play here. I have worked with the OIG in audits and know this first hand.
Nancy
HPI follow up
I agree with you. If you have a specific payor that has provided a tool or specific guidelines, you will follow those for that payor. I noticed someone had a post about WPS. Those guidelines are specific to WPS but may or may not apply to other carriers.
First, we apply correct coding rules per the AMA and we know the AMA incorporated the 1995 and 1997 E&M Guidelines to support the CPT defined E&M codes.
At the payor level, whether it is Medicare, Cigna, etc, we can apply the rules related to the E&M for that payor only and only after you have written guidelines from that payor.
It is always best to be consistent and follow the AMA CPT coding rules and then apply payor specific rules to that payor.
The posted 1995 and 1997 Guidelines do not include the three chronic conditions in the 1995 Guidelines, thus I cannot advise to apply the three chronic conditions to the 1995 rules. There are many sources that state you cannot mix the two guidlines.
I hope this helps and makes it more consistent with what the person presenting was trying to outline and describe.
Mary LeGrand, RN, MA, CCS-P, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com
Visit www.karenzupko.com for more information on National Coding Courses sponsored by AANS, AAOHNS, ACS, ASPS, SVS, AAOS and presented by KarenZupko & Associates,Inc.
