Practice Management Alert

Question: When my pediatrician writes "Neck is supple," should I count the phrase as part of the musculoskeletal exam or the lymph system when tallying the E/M level?

Alabama Subscriber

Answer: Supple means "able to bend." So you can always give the physician credit for the phrase "Neck is supple," as range of motion under the musculoskeletal section.

Some providers may use the phrase to refer to the lymph system. The term "Neck is supple" has also come to mean the physician checked the patient's node and found no swelling, meaning the patient doesn't have enlarged lymph nodes. Not all physicians like using the term this way.

Regardless of which way your practice feels, be careful that you don't double-count the phrase. You can use the note under either the musculoskeletal system or the lymph system, but you shouldn't count it under both exams at the same time.

Exception: You can consider the term part of both systems if the note states, "The neck is supple without adenopathy." That means the neck is bendable and the nodes aren't swollen.

Communication is key: Discuss this as a practice. Ask the practitioners what they are looking for and what they specifically mean when they refer to the neck as supple.