Wiki E/M coding according to Marshfield audit tool

[rthames052006]

Hello,

I'm back with more questions about this particular audit tool, I am trying to familiarize myself with this tool for the purpose of sitting for the CEMC next month.

I have purchased the Practicum for CEMC, my local Medicare carrier's tool is not the same as this but I am willing to learn this one for the sake of the exam.

The problem I am having is deciphering the exam portion of this tool, what is the difference between a EPF exam and detailed when it states for EPF is 2 limited and detailed would be 2 extended. I guess I am so used to my carriers tool and how they decipher between the two and I just need to understand in order for it to "sink in my skull".

Anyone who is familiar with this tool... Please help!!!

 

[gailmc]

This is how we train our coders on 2-7 limited vs. 2-7 detailed:
Using the 1997 Documentation Guidelines, limited requires 6 or more bullets and extended requires 12 bullets or more. In order to meet the 1995 Guidelines of limited, we need to have around 6 bullets; for a detailed exam, we need to have around 12 bullets. Some coders, in order to feel compliant, need to have 6 / 12 or more exactly. Other coders are comfortable with around 6 or around 12, whichever you can defend. We use both guidelines, but rely on bullets to help justify the exam component. Hope this helps.

 

[rthames052006]

This is how we train our coders on 2-7 limited vs. 2-7 detailed:
Using the 1997 Documentation Guidelines, limited requires 6 or more bullets and extended requires 12 bullets or more. In order to meet the 1995 Guidelines of limited, we need to have around 6 bullets; for a detailed exam, we need to have around 12 bullets. Some coders, in order to feel compliant, need to have 6 / 12 or more exactly. Other coders are comfortable with around 6 or around 12, whichever you can defend. We use both guidelines, but rely on bullets to help justify the exam component. Hope this helps.

Thanks for your response. I guess my problem (s) lie more on how this CEMC exam is going to be graded, they say you cannot mix 95 with 97. So if I use the 95 DG's for the history component I need to use the 95 exam also.

I'm going to contact AAPC in regards to this.

Thanks again,

 

[FTessaBartels]

Detailed vs EPF

The 1995 guidelines for EPF exam state that there is a LIMITED exam of the affected body area or organ system, plus other related systems.

The 1995 guidelines for DETAILED exam state that there is an EXTENDED exam of the affected body area or organ system, plus other related systems.

So for an example: patient presents with a wrist injury, fell off bike.

EPF: BP 102/70, temp 98.6, pulse 78. Left wrist swollen, with obvious bruising.

DETAILED: BP 102/70, temp 98.6, pulse 78. Left wrist swollen, with obvious bruising. No abrasions or lacerations. Range of motion limited due to pain. No tingling or cyanosis in fingers. Strength of grip on left significantly less than on right due to pain and swelling on left. Right wrist has full range of motion without pain.

In both these examples you have only TWO systems covered. But in the first example the exam of the affected body area/system is limited. While in the second scenario there is an extended exam of the affected body area (including comparison exam of the "normal" extremity).

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[rthames052006]

The 1995 guidelines for EPF exam state that there is a LIMITED exam of the affected body area or organ system, plus other related systems.

The 1995 guidelines for DETAILED exam state that there is an EXTENDED exam of the affected body area or organ system, plus other related systems.

So for an example: patient presents with a wrist injury, fell off bike.

EPF: BP 102/70, temp 98.6, pulse 78. Left wrist swollen, with obvious bruising.

DETAILED: BP 102/70, temp 98.6, pulse 78. Left wrist swollen, with obvious bruising. No abrasions or lacerations. Range of motion limited due to pain. No tingling or cyanosis in fingers. Strength of grip on left significantly less than on right due to pain and swelling on left. Right wrist has full range of motion without pain.

In both these examples you have only TWO systems covered. But in the first example the exam of the affected body area/system is limited. While in the second scenario there is an extended exam of the affected body area (including comparison exam of the "normal" extremity).

Hope that helps.

F Tessa Bartels, CPC, CEMC

You are a lifesaver Tessa, might sound silly but now I get it!!! Thank you so much for your "scenerio". Have you ever thought about being a teacher, you'd be excellent. Let me write this down in my books so I can keep focused.

Thanks again,