July 1999 AAOS Report

AMA CPT panel submits E&M revisions to HCFA

The CPT Editorial Panel of the American Medical Association (AMA) recently submitted its recommendations to the Health Care Financing Administration (HCFA) on revisions to HCFA's documentation guidelines for evaluation and management (E&M) codes. The AMA said the changes recommended by the CPT Editorial Panel emphasized clinical communication as the primary tool of the medical record and the need for confidentiality; make requested revisions to the history, examination and medical decision-making guidelines components; revise body system examination elements on the draft guidelines in response to specialty and other requests; and identify ways to reduce the role of "counting" of examination elements by emphasizing the importance of the actual CPT definitions and of using all pertinent information in the medical record that bears on the level of E&M code. One of the panel's recommended revisions deals with the musculoskeletal examination portion of the E&M codes. The AMA indicated that after a period of review, they anticipate HCFA will begin pilot tests of guidelines reflecting the panel's input. After the pilot tests and refinement, HCFA is expected to announce its intention to replace both the 1995 and 1997 guidelines currently in use with a new version.


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