Wiki Detailed Exam

[dcraven]

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,
Debby

 

[amjordan]

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).

 

[Cottrell]

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.

Wendy

 

[Cottrell]

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.

 

[Jagadish]

Medicare did not change its stance in regards to detailed exam as per 1995 guidelines.

Please review the following source:

http://www.empiremedicare.com/cbtcou...m 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!

 

[srarick]

Debby,

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!
Susan