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Expanded PF vs detailed exam

mpl5btx

Contributor
Messages
13
Best answers
0
:confused:I need to know what is the difference between a Expanded PF(limited) vs Detailed(extended) exam using 95 guidelines. They both require 2-7 BA/OS but I can't find a clear definition for what is meant by limited and extended. Any help is greatly appreciated.
 

hewitt

Expert
Messages
390
Location
Manhattan, NY
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0
The 1995 Coding Guidelines do not give a clear definition of what distinguishes an EPF from a Detailed exam. Our Medicare carrier will accept at least two elements identified by a bullet from a minimum of two organ systems. We have this in writing, so that's what we go by.
 

CBaer

Networker
Messages
70
Location
Dillsburg, PA
Best answers
0
Exp Prob Focus vs Detailed exam

You really need to question your carriers. As for Medicare CMS has left this up to the contracted mac's to determine.

Highmark Medicare Services (soon to be "Novitas Solutions, Inc") has a 4X4 rule, however keeping in mind clinical judgement may override this ruling.

I believe Trailblazer is 2-4 exp prob focus and 5-7 detail.

keep in mind although they require the same number of body areas/organ systems, if selecting detailed one of those two systems should detailed in nature.

Hope this helps.

Cheryl
 
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