The Health Care Financing Administration (HCFA) and the American Medical Association (AMA) have released changes to the documentation guidelines for Evaluation and Management (E/M) services. The changes to the guidelines become effective October 1, 1997, but there was to be a three-month (since extended six additional months, see above) grace period until January 1, 1998. All providers should be using the new guidelines by that date. These guidelines are for Medicare patients only until 1999. The new guidelines are expected to be included in the CPT book for 1999. They apply to all specialties providing any E/M service in all sites of service (office, hospital, etc.).

The major changes are in the area of documentation of physicial examinations. The four types of physical exams, problem focused, expanded problem focused, detailed, and comprehensive have been redefined with greater numeric requirements for documentation of elements performed in the exam. In most cases the number of required elements has more than doubled. Considering the increased requirements and the specific elements the physician must include, the new guidelines will have a dramatic impact on every practicing physician. A comparison of current charts recoded under the new guidelines typically results in a one or two level decrease in E/M code assignment. Failure to properly apply the new guidelines could translate to a decrease in reimbursement of up to 30% for an emergency medicine practice. For Emergency Department services there is an "acuity caveat" that exempts physicians from documenting a comprehensive history and/or physical exam due to the urgency of the patient's presenting problem.