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Thread: count body areas and organ systems

  1. #11
    Join Date
    Apr 2007


    AAPC: Back to School
    I asked the original question...I am going to try to clarify what I am finding when I go to the physicans practices.
    IF there were two body areas and 2 organ systems that were unrelated, lets say GI, repsiratory and then two body areas neck and extremity...I would count that as 4 by fitting the neck into the musk skeletal organ system and extremity into the cv sytem. If however, I already had used the musk skeletal and the cv system marked then I would only count two organ systems. Either one would give me an Exp Problem Focused Exam but sometimes it makes a difference.


  2. #12
    Join Date
    Apr 2007
    Milwaukee WI

    Default 1995 guidelines

    Our 1995 audit tool allows us to count body area and/or organ system (i.e. you can mix them) for an EPF or detailed exam.

    For comprehensive exam you must have 8 organ systems.

    The 1995 guidelines just state that you need 2-7 body areas and/or organ systems for an EPF or detailed exam. Some have refined this to be 2-4 BA and/or OS for EPF; 5-7 for detailed.

    debaloia states: To get a Detailed Exam we have to apply the 4 X4 rule which means 4 bullets in 4 different systems.
    This sounds like a hybrid of the 1995 and 1997 guidelines to me. (Since 1995 doesn't have any "bullets," and 1997 would require 2 bullets from each of 6 areas/systems OR at least 12 bullets in 2 or more areas/systems.

    Regardless, if your local carrier (Highmark or whoever) has specific guidelines then you'd be wise to follow them for that carrier.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 03-11-2009 at 11:40 AM.

  3. #13
    Join Date
    Apr 2007
    Greeley, Colorado


    Very interesting...
    My audit tool states body area OR organ system (no and).
    Maybe I better look into a new tool?

    But I am absolutely certain that in previous E/M seminars and workshops I came away with the understanding that you could not mix body areas with organ systems for a 95 exam. I'm working fom home today, my workshop material is at my office. I'll have to review that...
    Lisa Bledsoe, CPC, CPMA

  4. #14
    Join Date
    Apr 2007
    Kingsport, TN


    This is what I get from the guidelines... Correct me if I am wrong...please. Just like all of you, I want to audit this correctly!

    Level of Examination
    □ 1 organ systems OR body area
    Problem Focused
    □ 1 organ system or body area AND organ system(s) limited
    Expanded Problem Focused
    □ Affected body area(s) AND other organ system(s) extended
    □ General multi-system OR complete single organ system exam

    Here is the link to CMS website


  5. #15


    This is an interesting thread. Tell me if the EMR templete for GI physician list abdomen can I count that as GI? they are GI physicians after all!

    Quote Originally Posted by ARCPC9491 View Post
    The 1995 guidelines ALLOW you to use BODY AREAS and ORGAN SYSTEMS...

    The following Body Areas are recognized:
    Head, including face
    Chest, including breasts and axillae
    Genitalia, groin, buttocks
    Back, including spine
    Each extremity

    Organ Systems:
    Ears, nose, mouth, throat

    You documented:
    General/Constitutional - Organ System
    HEENT- Organ System
    Neck- Body Area
    Heart, CV- Organ System
    Lungs, Respiratory- Organ System
    Abdomen, GI- Organ System
    Neurologic- Organ System
    Extremities- Body Area ....... how many extremities were examined?

    You have 6 organ systems, and 2+ body areas (depending on how many extremities examined)

    Either way you look at it, you have (documentation supporting of course) a detailed exam based on the 1995 guidelines.

    In order to get a comprehensive with the 1995 guidelines, you have to have 8 organ systems examined and documented. Body areas DO NOT count in a comprehensive exam.

    It is not appropriate to "assign" body areas to organ systems.

  6. #16
    Join Date
    Apr 2007
    NCF Gainesville

    Default 95 Guidelines

    For a problem focused exam, expanded problem focused, or detailed, you can use areas and systems combined. For a comprehensive exam you have to have at least 8 systems. Think about it this way, to get that "comprehensive" they want you to exam a "system" not just and organ. Hope that helped some!

    Jeni Smith, CPC
    Jeni Smith, CPC, CPMA

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