Wiki e/m comprehensive exam vs detailed exam

[Kcronin1122]

Hello,
I am having a hard time with one of my doctors with billing for a complete comprehensive exam. I am only counting 7 Organ systems in their exam. Can anyone else look at the exam below and tell me how many organ systems they are finding?

General appearance: alert, cooperative, no distress
Head: Normocephalic, without obvious abnormality
Eyes: negative findings: No redness or drainage
Neck: supple, symmetrical, trachea midline, no carotid bruit and no JVD
Back: no skin lesions, erythema, or scars, no tenderness to percussion or palpation
Lungs: clear to auscultation bilaterally, no crackles, no wheezes, chest expansion normal
Chest wall: left sided chest wall tenderness at times, not consistent
Heart: RRR, normal S1 and S2, no murmur, no S3 or S4, no rub
Abdomen: soft, present bowel sounds, tender to palpation at left upper quadrant which patient states is chronic
Extremities: extremities normal, atraumatic, no cyanosis or edema
Pulses: 2+ and symmetric
Skin: Skin color, texture, turgor normal. No rashes or lesions
Neurologic: Alert and oriented X 3

Thanks

 

[Kcronin1122]

Also, would this be considered Musculoskeletal----
Extremities: No edema, pedal pulses 2+ bilaterally, no ulcers or lesions noted, no skin breakdown noted

 

[OhioMB]

It would depend on the Guidelines you are billing with, either 95 or 97?
97 Guidelines - Detailed
95 Organ Systems - Comprehensive

Also, would this be considered Musculoskeletal----
Extremities: No edema, pedal pulses 2+ bilaterally, no ulcers or lesions noted, no skin breakdown noted <--no you're in cardiovascular & skin

 

[Kcronin1122]

If I'm billing with the 95 guidelines how are you getting 8 organ systems. I am only counting 7
Constitutional
Eyes
Lungs (resp)
Heart (Cardio/vasc)
Abdomen (GI)
Skin
Neuro

Please help me understand what I am missing.

 

[bforr]

I'm getting the same seven systems you are. I don't see an eighth.

 

[avhadvidya@gmail.com]

8th one is alert which we can consider from constitutional as a psych...hence according to 95 guidelines 8 systems are there i.e com.

 

[Kris78]

I came out with 8 also!

Constitutional
Eyes
Cardio
Resp
Gastro
Musc
Skin
Psych

 

[NishaJ]

Im also agree with 8 exams..
I have read in one Medicare E&M FAQ.they suggest to count "Head: Normocephalic" and Atramautic under Musculoskeletol...