DEPARTMENT OF HEALTH & HUMAN SERVICES                    Health Care Financing Administration

‘9
	APR 28, 1999	7500 Security Blvd
		Baltimore, MD 21244-1850

Dear Ms xxxxxxxxx

This is in response to your inquiry regarding the use of scribes in physician practices. You state that the use of scribes is occurring among physician practices in the Wisconsin area

The evaluation and management (E/M) service is a face-to-face encounter between the patient and the physician. The scribe functions as a recorder of facts and events which occur between the physician and the patient during the encounter. Medicare policy is not opposed to the use of personnel as scribes. However, there must be evidence that the physician reviewed and confinned what is stated by the scribe. Medicare does not pay separately for the use of’s scribe.

Specifically, as stated in the ELM documentation guidelines, the hIstory portion of an encounter, i.e., review of systems or pastlfamnily/social history, may be recorded by ancillary staff or on a form completed by the patient. The physician must document with a note that s/he reviewed the information by either supplementing or confirming the infonnation recorded by others.

I hope this information is helpful to you.

Sincerely,

Terrence L. Kay
Director
Division of Practitioner and Ambulatory Care
Plan and Provider Purchasing Policy Group
Center for Health Plans and Provider