Trailblazer prohibits "all other systems negative"
Will the documented phrase or templated chart check off box "all other systems reviewed and negative" suffice in meeting the ROS requirements for a complete review of systems?
A. CMS 1995 and 1997 Documentation Guidelines both state that after pertinent positives and negatives have been addressed, then the statement "all other systems reviewed and negative" meets CMS documentation requirements for a complete ROS. When documented in this manner, some auditors assume that the physician has reviewed all 14 systems.
This ROS caveat, however, may be in jeopardy. Recently TrailBlazer Health Enterprises, the Part B Medicare carrier for Delaware, D.C., Maryland, Virginia and Texas has developed a supplementary guideline that will require the physician to comment on at least 10 systems individually to reach a complete review of systems. ACEP is monitoring this situation, and recommends you check with your local carriers and payers for their policies regarding the use of this caveat.
http://www.acep.org/practres.aspx?id=30474
There are two components to the TrailBlazer audit tool that worry physicians: It says that it won't give credit in the Review of Systems for cases where a physician discusses some systems and then writes "all other systems negative." Also, TrailBlazer has created a complicated points system for Medical Decision Making.
Emergency physicians, in particular, are very concerned that the audit tool isn't applicable to emergency medicine and will limit their ability to code 99284 or 99285 encounters. They point to the fact that they won't gain a point for "direct visualization," and that reviewing and summarizing old records and discussing the case with another provider are each only one point.
So far, no physicians have reported being audited using the new tool, but TrailBlazer has been defending its right to use it. And the Centers for Medicare & Medicaid Services stood up for TrailBlazer at the Nov. 3 physician Open Door Forum. Quinten Buechner with ProActive Consultants in Cumberland, WI asked CMS officials about the TrailBlazer policy, and they responded that carriers have a right to make their own policies...
http://medicalnewswire.com/artman/publish/article_7163.shtml 