Why might a provider choose between the 1995 and 1997 guidelines for an Evaluation and Management service?

A provider may choose between the 1995 and 1997 guidelines for an Evaluation and Management (E/M) service primarily to determine which set of guidelines offers a more advantageous approach for coding purposes. Both sets of guidelines aim to define how to appropriately document and bill for E/M services, but they have subtly different requirements regarding the elements of history, examination, and medical decision-making.

For instance, the requirements for levels of service can differ between the two guidelines, which may lead to variations in billing and reimbursement. By evaluating the specifics of a patient's visit in conjunction with both guidelines, providers can optimize their coding for maximum accuracy and reimbursement. This strategic choice allows for a more tailored approach that can better capture the complexity of the services provided while ensuring compliance with regulations.

Other considerations, such as the existence of insurance policies, may influence a provider's decision but generally, the primary focus remains on which guideline yields the best coding outcome for the particular situation. Choosing the most advantageous set of guidelines ultimately supports efficient revenue cycle management.