I agree...I think it's a matter of the carriers interpretation of what constitutes a detailed exam. Some carriers require 5-7 organ systems for a detailed 95 exam...others may allow 2-7.
My carrier's view....
Question: What's the difference between an expanded problem-focused exam and a detailed exam?
Answer: Per the 1995 E&M guidelines, the least level of exam involves a limited examination of the affected body area or organ system. The highest level exam, i.e. a comprehensive exam, is defined as a general multi-system examination or complete examination of a single organ system. Furthermore, a general multi-system examination is described as including findings about 8 or more of the 12 organ systems. Therefore, both an expanded problem focused exam and detailed exam may include assessment of 2-7 organ systems. As a detailed exam is expected to involve a greater work effort than an expanded problem focused exam, it is generally perceived that a detailed exam assesses more systems than an expanded problem focused exam; and, subsequently, the question is asked where the line of demarcation between the two exam types is. Many inquirers have asked us “does an exam become detailed at the 5th system addressed…or is it at the 6th system? CMS doesn't specify. In fact, CMS describes the exams as follows: “ Expanded Problem Focused” is a limited examination of the affected body area or organ system and other symptomatic or related organ system(s) whereas “Detailed” is an extended examination of the affected body area(s) and other symptomatic or related organ system(s).
As a carrier we are reluctant to set what could be an arbitrary parameter. In the E&M reviews we do, we determine the level of exam based on this range/number of systems but also on the amount of exam effort that was medically reasonable and necessary for the provider to diagnose and treat the patient. Providers are cautioned not to perform/document exam elements greater than the patient's need in order to claim a greater level of work and justify billing a higher level of service than the patient required.