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Old 07-15-2013, 09:53 AM
Tonyj Tonyj is offline
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Default Complete exam of a single organ system

My MAC is Novitas. Under the exam portion of the auditor's instruction, comprehensive exam is 8 or more systems or a complete exam of a single organ system. What constitutes a complete exam of a single organ system? Is that in reference to '97 specialty guidelines? Any assistance would be appreciated.
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Old 07-15-2013, 12:48 PM
Monika Liddle Monika Liddle is offline
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Default Complete exam of a single organ system

They are referencing that a provider can use the '95 or '97 guidelines.

When using the '97 General Multi-System Guideline table it identifies the system/body area along with the elements of examination (bulleted items). In order to count the system complete each bulleted item must be completed in that particular system.


In '95 Guidelines you typically count organ systems: constitutional, eyes, ENT, Cardio, Respiratory, GI, GU, Musculoskeletal, Integumentary, Neurological, Psychologic, and Hematologica/lymphatic/immunology.
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Old 07-16-2013, 08:25 AM
LLovett LLovett is offline
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Default Nobody knows....

They can't possibly be referring to 97 since none of the "single" system exams actually involve only one system. That option is in fact part of the 95 guidelines.

I have been thru several Novitas educational sessions, as well as many other carriers, and so far none of them have ever defined the single system comprehensive exam stated as an option for 95. When I asked Novitas point blank, I was told that it would be reviewed on a case by case basis by their nurse auditors and would be based on a clinical decision. So what might meet the requirement in one case might not in another.

My advice to providers has always been to just not go there. Use the 8 or more or one of the 97 single system exams.

Laura, CPC, CPMA, CEMC
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Old 07-16-2013, 09:12 AM
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MnTwins29 MnTwins29 is offline
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I tell our physicians the same thing that Laura tells hers - don't try to use the comprehensive exam of one system (we use 95 guidelines). Without clear guidance, it is left to opinions, and that can change from person to person.

There was another discussion thread here where someone was asking about what would constitued a comprehensive exam of just the skin/integumentary system. I wasn't going to touch that one - what I say and what a government auditor would say can be very different!
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Old 07-17-2013, 06:59 AM
Tonyj Tonyj is offline
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Thank you all for your responses.
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