Detailed Exam


Local Chapter Officer
Rome, GA
Best answers
Does anyone have any information where Medicare changed their stance regarding the requirements for a detailed exam? At one time CMS required 2 systems with detail documented to have a detailed exam. I am hearing now that CMS will accept one organ system with detail to have a detailed exam
Thank you,
I have seen various audit tools that have various formulas for a detailed exam based on the 95 Guidelines. I don't know that anything may have necessarily changed, but you could start with you Medicare carrier. When I work with physicians I tend to go with the 2 or more systems with Detail. If you read the guideline below literally, it should be at least 2 or more with detail.

Detailed -- an extended examination of the affected body area(s) and other symptomatic or related organ system(s).
I found a power point presentation done by Noridian (our local carrier) that had it broken down this way:

PF=1, EPF= 2-4, D=5-7. C=8 or more.

Hope this helps.

recalled powerpoint

According to Linda Windley at Noridian, this powerpoint presentation was requested to be taken off of their website on April 23, 2008 because they could not verify the 2-4 for the expanded exam and th 5-7 for the detailed exam. She stated to continue to use the 95 or 97 guidelines.

So I guess it is back to the vaugeness of Medicare. Sorry guys.
Medicare did not change its stance in regards to detailed exam as per 1995 guidelines.

Please review the following source: Levels.pdf

Detailed. An extended examination of affected body area(s) and other
symptomatic or related organ system(s) (up to 7, at least two items per system).

Hope this helps!

Per '97 Guidelines, a detailed exam requires 12+ bulleted elements in 2+ systems.

Per '95 Guidelines, a detailed exam requires 2-7 systems - more detail.

I'm in Ohio - so the Medicare Carrier is Palmetto.

Hope this helps!