April 13, 1998

Jane M. Orient, M.D.
Executive Director
Association of American Physicians and Surgeons Inc.
1601 N. Tucson Blvd. #9
Tucson, AZ 85716-3450

Dear Dr. Orient

This letter is in response to yours of April 8, 1998. Your letter reports that, in an April 8, 1998 conversation with Kathryn Serkes, Public Relations Counsel of the Association of American Physicians and Surgeons, Inc. (AAPS), I stated that "the new E&M Documentation Guidelines will not constitute regulations and will have no legal force or effect." You ask me to respond immediately in writing because you intend to "disseminate this information to others soon."

I did speak with Ms. Serkes in response to her call to me. In our conversation, Ms. Serkes referred to these guidelines as "rules." My response to her characterization reflected the first paragraph of the Forward of the 1997 guidelines document available on the HCFA website, that "The mutual goal [of HCFA and the AMA for these guidelines] is to provide physicians and claims reviewers with advice about preparing or reviewing documentation for evaluation and management services." In addition, the introductory material to the publication of the Guidelines in the AMA's monthly CPT Assistant publication (July 1997, reprinted October 1997) stated that "However, it is important to note that these are guidelines, not a law or a rule."

My comments reflected these statements, which I expect to remain in effect for the next, much improved version. Please do not attribute anything to me or the AMA other than these statements. They accurately reflect our understanding of the intent of the guidelines. I look forward to meeting you on April 27.


Mark J. Segal, Ph.D.
Vice President - AMA Strategic Market Programs