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Wiki body Area vs Organ System

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hmagao

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I posted this last week and got no response, so I am gonna try it again.

Does anyone know if when auditing the exam portion, is it body area OR organ system, or is it body area AND organ system? Also, is a referral out to another physician considered "additional work-up"?

Any help appreciated.
Thank you
 
There was another thread on this in the 'E/M' forum. My interpretation is that you can count Body Areas and Organ systems for a Problem Focused, Expanded Problem Focused, and Detailed exam. In other words, yes you can mix-and-match Body Areas and Organ systems. For the Comprehensive exam however, it must be 8 organ systems - body areas DO NOT count.

Regarding the exam, as well as your other question about additional work-up, My advice to you would be to pose that very question to your local Medicare carrier so that you have their response in writing. If you do, please feel free to share with us. The same applies to common questions like "What is the difference between a self-limited or minor problem, and a new problem with no workup required?" and "What is the definition of intensive monitoring for toxicity?" or "How old are old records?"
 
I would also check with your Medicare contractor to see if they allow the mixing of body areas and organ systems. Our old contractor (Pinnacle) did; however, the new one (Novitas) does not.
 
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