count body areas and organ systems

debaloia

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Hi,
I am seeing alot of physicians mix body areas such as Neck and Extremities with organ systems. I try to make the Neck and Extremities fit into the Body Organs so that they can still be counted.

How would you count the following:
General, HEENT,Neck, Heart, Lungs, Abdomen, Neurological exam, Extremities, Rectal Exam deferred.

I counted 1 General as Constitutional
2 Neck as Muskular Skeletal
3 Heart as CV
4 Lungs as Respiratory
5 Abdomen as GI
6 Neuro


I did not count Extremities because I thought that would fall into CV and I did not count deferred Rectal exam because I thought that would fall into GI and that both organ systems have been already counted.

Please let me know what you think? and if you also get 6

thanks!
 

ARCPC9491

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The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS...

The following Body Areas are recognized:
Head, including face
Neck
Chest, including breasts and axillae
Abdomen
Genitalia, groin, buttocks
Back, including spine
Each extremity

Organ Systems:
Constitutional
Eyes
Ears, nose, mouth, throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Skin
Neurologic
Psychiatric
Hematologic/Lymphatic/Immunologic


You documented:
General/Constitutional - Organ System
HEENT- Organ System
Neck- Body Area
Heart, CV- Organ System
Lungs, Respiratory- Organ System
Abdomen, GI- Organ System
Neurologic- Organ System
Extremities- Body Area ....... how many extremities were examined?

You have 6 organ systems, and 2+ body areas (depending on how many extremities examined)

Either way you look at it, you have (documentation supporting of course) a detailed exam based on the 1995 guidelines.

In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam.

It is not appropriate to "assign" body areas to organ systems.
 
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debaloia

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Do you know if that is the same for all states? I thought you had to use either Body Areas or Organ systems and could not mix them. I

We are in Pennsylvania and go by Highmark Medicare Services

To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems.

Thanks for responding. I want to know how everyone views this as I am getting many different answers here.

The highmark medicare website is very vague.

thanks
 

ARCPC9491

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hmm.... well the guidelines are the guidelines. The contractors can interpret them the way they like. I have a different contractor, and I'm not aware of the 4x4 rule.... sorry I couldn't help!
 

ARCPC9491

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Interesting..I've always been taught you could and that's how I apply it..I need to stop doing that then. I primarily use 1997 guidelines thankfully!
 

RebeccaWoodward*

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Now that's interesting.

My auditing software has it broken 3 ways. One template for body areas...one template for organ systems...and one template with both

Now I'm confused....:confused: I'm going to check this out.
 

ARCPC9491

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LOL... it's always something right Rebecca.... I'm just as confused as you... I'm going to look into it too. Let me know what you find!!
 

ARCPC9491

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Lisa-
What are you referring to when you say you can't use body areas/organ systems combined?:confused:

I know you can't for a comprehensive exam... as per my previous statement... "In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam."
 

debaloia

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AR-
I asked the original question...I am going to try to clarify what I am finding when I go to the physicans practices.
IF there were two body areas and 2 organ systems that were unrelated, lets say GI, repsiratory and then two body areas neck and extremity...I would count that as 4 by fitting the neck into the musk skeletal organ system and extremity into the cv sytem. If however, I already had used the musk skeletal and the cv system marked then I would only count two organ systems. Either one would give me an Exp Problem Focused Exam but sometimes it makes a difference.

Thanks
 
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1995 guidelines

Our 1995 audit tool allows us to count body area and/or organ system (i.e. you can mix them) for an EPF or detailed exam.

For comprehensive exam you must have 8 organ systems.

The 1995 guidelines just state that you need 2-7 body areas and/or organ systems for an EPF or detailed exam. Some have refined this to be 2-4 BA and/or OS for EPF; 5-7 for detailed.

debaloia states: To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems.
This sounds like a hybrid of the 1995 and 1997 guidelines to me. (Since 1995 doesn't have any "bullets," and 1997 would require 2 bullets from each of 6 areas/systems OR at least 12 bullets in 2 or more areas/systems.

Regardless, if your local carrier (Highmark or whoever) has specific guidelines then you'd be wise to follow them for that carrier.


F Tessa Bartels, CPC, CEMC
 
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Lisa Bledsoe

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Very interesting...
My audit tool states body area OR organ system (no and).
Maybe I better look into a new tool?

But I am absolutely certain that in previous E/M seminars and workshops I came away with the understanding that you could not mix body areas with organ systems for a 95 exam. I'm working fom home today, my workshop material is at my office. I'll have to review that...
 

kmhall

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This is what I get from the guidelines... Correct me if I am wrong...please. Just like all of you, I want to audit this correctly!

Level of Examination
□ 1 organ systems OR body area
Problem Focused
□ 1 organ system or body area AND organ system(s) limited
Expanded Problem Focused
□ Affected body area(s) AND other organ system(s) extended
Detailed
□ General multi-system OR complete single organ system exam
Comprehensive

Here is the link to CMS website

http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp
 

ylizcontreras

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This is an interesting thread. Tell me if the EMR templete for GI physician list abdomen can I count that as GI? they are GI physicians after all!


The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS...

The following Body Areas are recognized:
Head, including face
Neck
Chest, including breasts and axillae
Abdomen
Genitalia, groin, buttocks
Back, including spine
Each extremity

Organ Systems:
Constitutional
Eyes
Ears, nose, mouth, throat
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Skin
Neurologic
Psychiatric
Hematologic/Lymphatic/Immunologic


You documented:
General/Constitutional - Organ System
HEENT- Organ System
Neck- Body Area
Heart, CV- Organ System
Lungs, Respiratory- Organ System
Abdomen, GI- Organ System
Neurologic- Organ System
Extremities- Body Area ....... how many extremities were examined?

You have 6 organ systems, and 2+ body areas (depending on how many extremities examined)

Either way you look at it, you have (documentation supporting of course) a detailed exam based on the 1995 guidelines.

In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam.

It is not appropriate to "assign" body areas to organ systems.
 

jas0426

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95 Guidelines

For a problem focused exam, expanded problem focused, or detailed, you can use areas and systems combined. For a comprehensive exam you have to have at least 8 systems. Think about it this way, to get that "comprehensive" they want you to exam a "system" not just and organ. Hope that helped some!

Jeni Smith, CPC
 
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