1995 Exam Elements

[dballard2004]

Per the 1995 Exam elements, 2-4 body areas or organ systems are required for an expanded problem focused exam. Does this mean that it has to be 2-4 oragan systems, 2-4 body areas, or can it be both?

For example, if the documentation shows head and abdomen and cardio and ENT, is this considered four or just two?

 

[ARCPC9491]

It can be body areas and/or organ systems for problem focused, expanded problem focused and detailed.

For the comprehensive exam, it can only be 8 (or more) organ systems. No body areas.

 

[coder25]

Is true for all insurances??? I just came back from a Highmark Medicare Advance office and outpatient E/M Workshop where they said that Medicare does not allow you to mix or match for any level of exam. Were they given out wrong info??

 

[ARCPC9491]

hmm .... that is what the guidelines say!

now, each Medicare contractor can interpret the guidelines in whatever way they would like.

So it seems to me, they are going with OR instead of AND/OR

"Expanded Problem Focused: 2-7 systems and/or body areas"

May want to contact them to clarify.

 

[dballard2004]

Thanks so much for the replies.

 

[hthompson]

I think that it's and/or as long as you aren't counting one exam in more than one area. So, you can't count head and ENT if they just looked at ears, nose, throat, you'd only count ENT. If they had a bump on their head and that was examined and they also did an ENT exam, that'd count as 2.

 

[cwcieri@yahoo.com]

DG for 1995 state systems, not body area

We count only one body area for expanded problem focused and detailed exams. All the rest have to be organ systems. Per 1995 DG, "other symptomatic or related ORGAN systems" Ingenix also states, in their E/M book, only one body area may be counted, the rest are ORGAN systems.