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Comprehensive exam

  1. #1
    Default Comprehensive exam
    Medical Coding Books
    Does anyone use 95 guidelines when auditing neurology? I am struggling with the comprehensive exam. My physician does not do a cardiac exam so 97 guidelines would mean he never does a comprehensive exam but I am wondering if he would meet single organ system in 95 guidelines

  2. Default
    As long as you use the '95 guidlines all the way thru the entire service (don't interchange between meeting criteria for '97 in history and '95 in exam, that's a big no no) it is acceptable.

  3. #3
    Default comprehensive exam
    Do you know what a comprehensive exam for neurology would look like under 95 guidelines? My physician documents the following cranial nerves:
    2-10 examination, exam of sensation, deep tendon reflexes, orientation and gait and station. This would only meet detailed under 97 but I was wondering if it met comprehensive single organ in 95.

  4. #4
    Default 95 and 97 DG
    My understanding is you can combine the two DG (95/97 DG) in one instance:

    FAQ on 1995 & 1997 Documentation Guidelines for Evaluation & Management Services.
    Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code?
    A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013 physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service.

    The definition of a comprehensive exam per 95 DG is, "DG: The medical record for a general multi-system examination should include findings about 8 or more of the 12 organ systems."

    I don't see a comprehensive exam by 95 DG in your example.

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