tci ED Coding & Reimbursement Alert - 2003 Issue 2

Reader Question: CMS versus CPT for E/M Services

Question: Is there a difference between using CMS and CPT guidelines for E/M services? Many colleagues have told me that there's no difference between the two, and yet others make statements to the contrary. Are the guidelines really that different for E/M services? What guidelines do most emergency physicians use? Do they differentiate how they code for government payers versus commercial payers, or do they follow CMS guidelines for all payers? Texas SubscriberAnswer: There is no straightforward answer to your question, other to say that CPT and CMS guidelines are not identical. One downside to uniformly following guidelines by...

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