News: CMS seeks feedback on changing E/M billing guidelines

For the first time since 1997, CMS put out a call for feedback on changing the Evaluation and Management (E/M) guidelines, according to a July 13 press release from CMS. As the program stands, there are two sets of guidelines and providers can choose which to follow: one set of guidelines published in 1995 and another published in 1997.

While providers can choose between the two sets of guidelines, once they have chosen, the provider’s documentation must follow the chosen guidelines to the letter. Providers cannot pick and choose which components to follow from each set of guidelines.

The E/M guidelines—both from 1995 and from 1997—specify the kind of information required to support Medicare payment for each level. The three components to selecting the appropriate level are:

• History of present illness (history)
• Physical examination (exam)
• Medical decision making

The three components above are the building blocks of the documentation for all patient encounters, though not every encounter requires complete documentation of all three key components; some only require two out of three.

For fear that the decade-old guidelines may be outdated, CMS has begun the process of updating with a call for feedback. CMS requests comments on specific changes to undertake to “update the guidelines, to reduce the associated burden, and to better align E/M coding and documentation with the current practice of medicine,” according to the press release.

Specifically, CMS looks for feedback and suggestions for updating the history and exam components of the guidelines.

Editor’s note: For more information regarding the E/M guidelines and the proposed changes to the Medicare Physician Fee Schedule, click here.