In what situation might a provider choose the 1997 guidelines instead of the 1995 guidelines?

Choosing the 1997 guidelines over the 1995 guidelines may occur specifically in circumstances where the 1997 guidelines yield more favorable coding outcomes for the provider. The 1997 guidelines offer a more structured approach to evaluating and documenting levels of service based on specific elements of history, examination, and medical decision-making.

In scenarios where the coding outcomes significantly impact reimbursement or the level of care appropriately reflects the services rendered, the provider may prefer the 1997 guidelines. These guidelines are often seen as providing clearer definitions, which can lead to more accurate coding and billing.

The 1995 guidelines, while still valid, can sometimes be less detailed and may not capture the same level of complexity in patient care as outlined in the 1997 version. Thus, if a provider believes that using the 1997 guidelines will result in a better representation of the services provided and, consequently, a more favorable coding outcome, they may opt for those guidelines.