Wiki 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!
 
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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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
 
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!
 
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!
 
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.
 
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!!
 
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."
 
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
 
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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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...
 
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
 
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.
 
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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