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.-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Expanded PF vs detailed exam
- Thread starter mpl5btx
- Start date
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
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
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
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