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counting bullets

  1. #1
    Default counting bullets
    Medical Coding Books
    Hi,
    I was wondering if anyone could direct me to some written documentation, preferably from CMS, stating the maximum number of bullets possible for musculoskeletal and lymph exams using 1997 general multisystem guidelines?
    I am looking specifically for written documentation from CMS.

  2. #2
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    Daytona Beach, FL
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    Default
    Quote Originally Posted by chrissyr View Post
    Hi,
    I was wondering if anyone could direct me to some written documentation, preferably from CMS, stating the maximum number of bullets possible for musculoskeletal and lymph exams using 1997 general multisystem guidelines?
    I am looking specifically for written documentation from CMS.
    I am confused with your question. You need to know the maximum number of bullets for musculoskeletal and lymph for what level? There are 4 bullets under the lymph exam and under the muscularskeletal there are 6 areas to be reviewed with 4 bullets each (24 if all are done) and 2 additional bullets for gait and station and inspection of digits. Even if all of this is documented if this is the only areas reviewed, the exam would not be higher than a detailed.

    This is all listed on the 1997 specialty exam General Mutli-system auditing tool from CMS. You can find a copy at http://www.novitas-solutions.com and look for E/M 1997 specialty score sheets.

    If this is not the information you are looking for, please clarify your question!

    Thanks,
    Jodi Dibble, CPC

  3. #3
    Default
    Thank you Jodi for the Novitas link. I will research there and see if I can find what I'm looking for.
    As far as my question goes...I am wanting to know the maximum number of bullets possible for musculoskeletal and lymph systems. I am not looking for a specific level at the moment. I am aware that there are 4 bullets under lymph and 6 bullets under musculoskeletal. However, at my place of employement, there is a discrepancy in the way I interpret this and the way my leadership interprets it.
    I agree with you, that there is a possiblilty of getting 26 bullets in musculoskeletal if all 6 areas are examined. I also agree that there is a total of 4 bullets in lymph as long as 2 areas are examined. However, my leadership says that you can only get 1 bullet in lymph provided 2 areas are examined. AND that you can only get 6 bullets in musculoskeletal regardless of how many areas are examined.
    I have argued this several times. Leadership did take the lymph issue to our CMS contractor and they stated that it would only be 1 bullet. The only explanation I have gotten about the musculoskeletal issue is that you would have a possibility of 26 bullets if you performed a single specialty exam, but not general multi-system. They state that the E&M guidelines are worded differently for single specialty and general multi-system (which they are). But they don't specifically state that you don't get credit for each area.
    I was asking for written documentation because I have seen several posts on here asking the same questions. Everyone just gives their opinion, which is great. Except that it won't hold any value with my employer. :-)

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