Wiki AMA vs CMS exam components

[wynonna]

When I initially learned 1995 E&M Exam elements, my coding manager required 2 body areas or points per body or organ system to count. They were used to differentiate between problem focused, expanded problem focused, detailed and comprehensive/complete.
Would it be fair to say she was using the 1995 AMA guidelines? And that CMS requires only 1 body area per body or organ system to differentiate?
Thank you

 

[thomas7331]

I'm not aware that the AMA has ever published any E&M documentation guidelines or audit tools beyond what is given in CPT. The 1995 and 1997 documentation guidelines were both published by CMS. The 1995 guidelines do not specify any rules for counting 'points' for examinations of body areas or organ systems. Because the guidelines are somewhat vague and subject to interpretation, many organizations, both payers and providers, have developed audit tools to help direct coders on what is required. Some of these, such as the Marshfield Clinic tool, are widely used, but others are specific to given payers or providers.

Your coding manager may have been using a tool that required 2 components of documentation in a given area or system in order for it to be recognized. I have not encountered this in my career, but it could have been derived from something that one of your major payers published as a requirement, or it could have been something that they developed internally, perhaps as a result of audit finding, to help ensure documentation that support the codes billed. It's hard to say where this came from though.