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The Health Care Financing Administration (HCFA) has set up yet another process and tentative timetable to develop a series of vignettes for use with the agency’s long-delayed final Medicare evaluation and management (E&M) documentation guidelines.
However, both providers and HCFA officials are privately concerned these vignettes will be too little too late to satisfy physicians frustrated with the overall E&M protocol development marathon that been going on since the agency unveiled its first set of revised guidelines in 1995.
The goal of these new vignettes is to create real-life examples that physicians can follow when documenting the services they provide to Medicare patients.
To do this, HCFA has given Aspen Systems, a Rockville, MD-based information management company, a $600,000 contract to develop 600 vignettes for 20 specialties, says Paul Rudolf, MD, senior technical adviser at the agency’s Center for Health Plans and Providers.
These specialties include: cardiology, emergency medicine, endocrinology, family practice, gastroenterology, general surgery, internal medicine, neurology, neurosurgery, OB/GYN, ophthalmology, orthopedics, osteopathy, otolaryngology, pediatrics, podiatry, psychiatry, pulmonary medicine, rheumatology and thoracic surgery.
Examples will be developed for two of the three components of an E&M code: medical decision making and physical examination. HCFA has decided not to develop vignettes for the third component - patient history - because it hasn’t generated the same controversy as the other two areas, says Rudolf.
HCFA hopes to finish the examples by May or June. After that, they will be pilot tested.
Some medical societies are concerned about HCFA’s plan to develop examples for only three levels of medical decision making and physical exams even though CPT codes describe four levels of service for each component.
"We understand the potential confusion and are trying to address that concern," notes Rudolf.