Detailed (?) extremity exam with 1995 guidelines

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There isn't a lot of information out there about this, at least that I can find.

Here is my exam, and I'm trying to figure out if this justifies a "detailed" extremity exam.

VS: (documented but not reiterated here).
GENERAL: (documented but not reiterated here).
RESP: (documented but not reiterated here).
CVS: (documented but not reiterated here).
EXTREMITIES (LUE): Hand normal to inspection and nontender. Wrist normal to inspection and nontender. Forearm with bony and soft tissue tenderness, ecchymosis and swelling. Several areas of early ecchymosis, red/purple. Able to move elbow with FROM. Elbow with bony and soft tissue tenderness. Arm normal to inspection and nontender. Shoulder normal to inspection and nontender. Neuro: Sensation normal. Vascular: No vascular compromise. Skin: Warm, dry, intact.

(Side note: Some in our office count the above SKIN, VASCULAR, and NEUROLOGIC as their own Organ Systems rather than part of the EXTREMITIES exam which is where I count it in this example, due to the fact that it is not a full body SKIN, VASCULAR, or NEUROLOGIC exam and simply pertaining to that particular extremity.)

In addition, I've had an auditor tell me that if only one extremity is reviewed and documented, as opposed to all extremities, it should count as a MSK organ system rather than EXT body area. This is NOT how I understood it. She also has stated that she has never seen a "detailed extremity exam" with 1995 guidelines.

The above exam, under 1995 guidelines, I'm thinking is a Detailed exam due to being 2-7 with one in detail.

1) In the above example, is this a single EXTREMITY BODY AREA exam or MUSCULOSKELETAL ORGAN SYSTEM exam? Is the auditor I quoted above correct and I'm just misunderstanding?

2) Is the extremity exam given considered "detailed"?

Any direction is greatly appreciated.
 
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Detailed extremity exam with 1995 guidelines

Here are my thoughts. Under the 1995 guidelines, you would be looking at each extremity as a body area. The physician performed an extended examination of the extremity and noted examination of vitals and general (typically denotes level of distress from injury, rules out shock, etc) and related organ systems (vascular and neuro). This supports detailed examination. If the examination of the extremity were limited (eg, focused only on area of bruising), then expanded problem focused would be more appropriate.

The guidelines clearly state "each extremity" and permit use of body area rather than organ system so I agree with your thoughts on this.
 
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Here are my thoughts. Under the 1995 guidelines, you would be looking at each extremity as a body area. The physician performed an extended examination of the extremity and noted examination of vitals and general (typically denotes level of distress from injury, rules out shock, etc) and related organ systems (vascular and neuro). This supports detailed examination. If the examination of the extremity were limited (eg, focused only on area of bruising), then expanded problem focused would be more appropriate.

The guidelines clearly state "each extremity" and permit use of body area rather than organ system so I agree with your thoughts on this.
Thank you so much for your help!!
 
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